Serous membrane that houses ABD organs
Peritoneum
Which ABD muscle's fibers go up & down?
Rectus abdominus
Which ABD muscle's fibers go horizontally?
Transverse abdominus
Which ABD muscle's fibers go 45 degrees, towards midline?
Internal oblique
Which ABD muscle's fibers go 45 degrees, up & away from midline (towards lats)?
External oblique
What's the superficial/innermost layer of the esophagus?
Stratified squamous epithelium with goblet cells
What's the thick double layer of smooth muscle in the esophagus?
Muscularis externa
Peristalsis: What do the longitudinal muscles do ahead of a bolus?
Contract
What do the circular muscles do behind the bolus?
Contract
What nervous system controls peristalsis?
Enteric nervous system
When parasympathetic system triggers GI, what happens?
Rest & digest
When sympathetic system triggers GI, what happens?
Shut down to shunt blood away
What's another term for the sphincter between the esophagus & stomach?
Lower esophageal sphincter (LES)
What attaches the small intestine to the back of the abdominal cavity?
Mesentery (yellow folds, like that of the greater omentum)
What are the innermost muscle fibers of the stomach?
Oblique
What are the middle layer of muscle fibers in the stomach?
Circular
What are the outermost muscle fibers of the stomach?
Longitudinal
What are the ridges in the stomach called? What are they for?
-Rugaue
-Allows stomach to expand
Volume of stomach when empty?
When full?
-50mL
-4,000mL
What is the partially digested food called that enters the stomach?
Chyme
What's the pH range of the stomach?
1.5 - 3.5
What does acid in stomach do?
-Kills bugs
-Denatures proteins
-Starts breakdown of plant cell walls & meat connective tissue (collagen)
-Enables pepsin to function optimally (released initially as pepsinogen - acid in stomach activates it)
What are 4 layers of stomach, from outside to inside?
Serosa (Peritoneum) - muscularis externa - Submucosa (gastric gland) - Mucosa (gastric pit) (infoldings)
The specialized epithelial cells of the stomach are located in the __1__ gland, and secrete precursor of __2__ & _____ 3 _____
1. Gastric gland
2. Pepsin
3. Hydrochloric acid
Yellow cells in the gastric gland secrete what?
Useful hormones & other substances
What type of pain will a patient experiencing a gastric ulcer experience? When will they likely experience the pain?
-Epigastric pain
-After eating
The small intestine is mostly hidden behind this
Greater omentum
Most ulcers, due to high acidity, are located where in GI system (80%)?
Duodenum
How would subjective report of pain differ between gastric ulcers & duodenal ulcers?
Stomach - soon after eating
Duodenal - delayed pain
What does duodenum require to reduce acidity of chyme? Where does it come from?
NaHCO3; from pancreas
What contributes to duodenal ulcers?
Acidic pH; too low for NaHCO3
What are some meds/dietary items that contribute to ulceration of GI system?
-NSAIDs
-Caffeine
-ETOH
-Acidic foods/drinks (OJ, V8)
What potential life-threatening complication arises in children with cystic fibrosis in relation to digestion/nutrition? This is similar with pancreatic cancer.
They can starve without supplemental enzymes; secretion of pancreatic juice is blocked, so digestive enzymes required for digestion/absorption aren't available
Necessary for fat emulsification/digestion
Bile
Makes bile
Liver
Stores bile
Gallbladder
What 2 juices help breakdown fat?
Bile emulsifies; pancreatic juice breaks down into even smaller droplets for absorption
What happens to the villi as you move into the jejunum & ileum?
Jejunum - get taller
Ileum - disappear
Prevent leakage of contents in duodenum
Tight junctions between epithelial cells
Secrete mucus w/high pH to protect epithelium from acidic chyme
Goblet cells
1. Where do gastric epithelial cells start?
2. How long do they live?
1. Born in crypt & ride to tip of villi
2. 3-6 days (tough environment)
Crypt cells (at bottom of villi) secrete this hormone when fat moves into duodenum
Cholecystokinin (CCK)
Triggers brain to suppress appetite; causes release of bile from gallbladder
Cholecystokinin (CCK - from crypt cells under villi)
Absorbed from chyme by epithelial cells; released into interstitial fluid to freely pass into capillaries that innervate the hepatic portal venous system
Nutrients (sugars, aminos, vitamins, minerals)
Be able to tell where the following veins are located:
Superior mesenteric
Inferior mesenteric
Splenic vein
Hepatic portal vein
Superior M. - Down from triple branching
Inferior M. - Down after right branching
Hepatic portal v. - Up from triple branching
Splenic v. - right from triple branching (continues with upward branching from inferior mesenteric)
In the portal system, blood goes through how many capillary beds?
Where are they located?
-2
-First is in villi of small intestine; 2nd is inside liver
Since tiny lipid/protein droplets are still too big to enter the GI capillaries, what must happen?
They enter lacteals (lymph vessels); called chyle
Flow to subclavian vein to lymph ducts
Lipid extracted from chyme; in lymph
Chyle
Reservoir where chyle can accumulate; at base of thoracic duct
Cysterna chyli
Most common bariatric Sx
Gastric lap band
Part of intestine housing large # of bacteria that can digest things that we can't (i.e. plant material)
Cecum of ascending colon
No enzymatic digestion - only bacterial here
Large intestine
What is an important job of the large intestine?
H2O absorption
Out-pockets in the large intestine
Diverticulum
Inflammation of the out-pockets in the large intestine
Diverticulitis
What dietary adjustment can help diverticulitis?
More fiber in diet - hydrate!
Which organs or part of organs aren't located in the peritoneum, but rather in the retroperitoneal region?
-Part of duodenum
-Spleen
-Kidneys
What's the clinical significance of having part of the duodenum, as well as the entirety of the kidneys & spleen, in the retroperitoneal space (outside of peritoneum)?
You can operate on these organs without risking peritonitis
Carries blood to liver from entire digestive tract; loaded with nutrients
Hepatic portal vein
Liver is made up of approximately 200,000 hexagonal structures (lobules). Blood enters these through a group of how many vessels? What is this group called?
-3 vessels
-Portal triad
What does the portal triad vasculature consist of?
1. Hepatic portal vein (branch of) BLOOD IN
2. Hepatic artery (branch of) BLOOD IN
3. Bile duct (green) BILE OUT
What portion of the portal triad vasculature supplies nutrients from the GI tract?
Hepatic portal vein
What portion of the portal triad vasculature supplies nutrients & O2 to the hepatocytes?
Hepatic artery
Blood leaving the liver heads where?
Inferior vena cava
Lipid & protein packets created by small intestine epithelial cells that absorb lipid droplets
Chylomicrons
Travel from thoracic duct through circulation, getting partially digested by muscle & adipose cells (extracting triglycerides & some cholesterol) before getting "gobbled up" by liver
Chylomicrons
Major cholesterol transporter
LDL
If LDL's become too abundant, __1__ swallow them & become engorged (hanging around site of endothelial injury), becoming __2__ cells, which contribute substantially to CAD
1. Macrophages
2. Foam
Suck cholesterol out of foam cells, reducing plaque
HDL
What does amino acid breakdown in the liver produce, and what is it converted into?
Ammonia; converted into urea (less toxic) to be removed from kidneys (part of BUN lab if kidney function is compromised)
What 2 kinds of dysfunction contribute to jaundice (hyperbilirubinemia)?
1. Liver doesn't transfer bili to bile (i.e. neonatal liver can't keep up with bili levels)
2. Obstructive jaundice: Liver works, but a blockage is preventing bili from entering bile (i.e. block in bile duct from gall stones or CA)
What happens to hepatocytes in cirrhosis?
Die & are replaced by fibrous tissue (& new hepatocytes)
Major causes of cirrhosis
1. ETOH
2. Hep B/C
Portal HTN, part of cirrhosis, can be defined as?
Scar tissue build-up creates more resistance, requiring anastomoses to develop for bypass of blood; waste accumulates
What are some of the complications r/t cirrhosis?
-Hepatomegaly (RUQ pain)
-Portal HTN
-Ascites
-Jaundice
Caused by abnormal collateral circulation as a result of portal HTN
Esophageal varices (swollen regions of veins)
What are the kidneys directly attached to?
Descending aorta & inferior vena cava
Where are the kidneys?
Behind peritoneum (to left and right of L1 in picture)
Where's the spleen?
Purple-blue organ on far right
Where's the stomach?
Top center (to right of liver & superior to pancreas)
Why are the kidneys at greater risk of damage following a strong blow to the abdomen in comparison with the other abdominal organs?
The kidneys are fixed & can't move, increasing risk of damage
1. What makes up 50% of the nitrogenous wastes in urine?
2. What is this byproduct a result of?
1. Urea
2. Breakdown of amino acids in liver
How do the kidneys contribute to production of RBC's?
Erythropoietin
Know these parts:
-Renal cortex & medulla
-Renal pyramids
-Minor & major calyces
-Renal pelvis
-Renal artery & vein
-Cortex is outermost; medulla is middle portion that also contains the renal pyramids
-Renal pyramids are the triangular-shaped fibrous parts included in the medulla
-Minor calyces are small extensions from pyramids; major are the larger extensions from the minor
-Renal pelvis is the large collection from the major calyces
-Renal artery is bifurcated, smaller; renal vein is larger, singular
What are the 2 kinds of nephrons in the kidney?
-Cortical nephron (85%)
-Juxtamedullary nephron (15%)
A tangled ball of capillaries within the nephron
Glomerulus
What forms the filter in the glomerulus?
Walls of the capillaries
What are the 3 layers associated with glomerular filtration?
1. Capillary walls (porous - small proteins can squeeze through)
2. "Dense layer" (basement membrane - smaller holes)
3. Feet of podocytes form slits that only allow fine particles to pass
Why isn't filtrate in renal tubular system red?
No RBC's
How does blood, which doesn't normally go into filtrate, exit the glomerulus? Where does it go from there?
Efferent arteriole to the peritubular capillaries
3rd leading cause of kidney failure; filtration slits of podocytes can get clogged by antigen-antibody complexes if present in high concentration; autoimmune
Glomerulonephritis
Glomerulonephritis is an autoimmune attack on the glomeruli. What organism/s are linked to this inflammatory immune disorder?
Strep & Lupus
Strep throat usually; lupus is autoimmune disorder
65% of water in filtrate gets reclaimed here; active transport occurs here; substances leave filtrate & enter interstitial fluid; everything can freely pass into peritubular capillaries
Proximal convoluted tubule (PCT)
Substances are also pumped from interstitial fluid into filtrate at this location when undesirable elements fail to filter through glomerulus
Proximal convoluted tubule (PCT)
Most of the filtrate's water is moved to the interstitial fluid at this point in the nephron
Descending loop of Henle (DLoH)
Much of the Na+ content in filtrate is reabsorbed into circulation at this point in the nephron
Ascending loop of Henle (ALoH)
After passing this point in urine filtration, only about 10% of original Na+ content & 20% of original H2O content remain
Loop of Henle
What is an optional step in urine formation that occurs usually at the end of filtration, and is dependent upon systemic status & needs?
Adjustment of osmolarity & pH to correct problems with either systemically
If, at the end of filtrate formation, either the body doesn't need any osmolarity/pH buffering, or those changes have already occurred, what happens to filtrate?
Becomes urine
If blood is too acidic, what enters urine filtrate to adjust pH?
Hydrogen ions
Is it more common for blood to be more basic or more acidic?
Acidic; rarely basic
If blood osmolarity (concentration) is too high, what happens in the kidneys?
H2O is reabsorbed from filtrate into interstitial fluid
Key measurement of kidney function (rate)
GFR
What is the pressure difference inside the glomerulus?
-15mm Hg
Capillaries = 50mm Hg
Filtrate inside capsule = 35mm Hg
What are 3 mechanisms that maintain GFR rate of 110-120mL/min?
-Local pathway (special cells in PCT)
-JG cells around afferent arteriole (renin)
-Baroreceptors in carotid
Specialized local cells inside the PCT do what when they detect either low rate of filtrate or low Na+?
Dilate afferent & constrict efferent
When JG cells around afferent arteriole detect either low BP or low Na+ in filtrate, they release what hormone?
Renin
Raises GFR by constricting efferent arteriole
Angiotensin II
Causes adrenal gland to release aldosterone
Angiotensin II
Released by the adrenal gland under stimulus from angiotensin II, aldosterone acts on what part of the nephron?
DCT
Causes vasoconstriction of arterioles & precapillary sphincters, raising systemic BP
Angiotensin II
Causes release of ADH from brainstem & activates SNS = vasoconstriction
Angiotensin II
When baroreceptors in the carotid sinus detect low BP, they send signals to the __1__, which directs the __2__ gland to release __3__. This acts on the DCT & collecting ducts.
1. Hypothalamus
2. Pituitary
3. ADH
Leading cause of kidney damage & eventual failure
Diabetes
Excess glucose builds in the __1__, causing excess __2__ to remain in filtrate, resulting in __3__.
1. PCT
2. H2O
3. Hyperfiltration
How does diabetes, and subsequent hyperfiltration, caused nephron damage?
Causes chronic afferent arteriole constriction, reducing blood flow to peritubular capillaries, resulting in less blood supply to nephrons, which is damaging over time
How does hyperfiltration lead to proteinuria?
Thickens basement membrane (filter slits), causing a leaky filter that allows proteins to pass
Urination requires cooperation between what 2 systems?
Autonomic (internal sphincter) & voluntary control (external sphincter)
Bladder infections in women are almost always caused by what organism?
E. coli
What are 2 treatments for kidney stones?
Lithotripsy & SX
What are the 4 layers of the pelvis, starting w/innermost first?
-Bony pelvis
-Pelvic diaphragm
-Subperitoneal connective tissue
-Peritoneum
What 2 body cavities are continuous?
Abdominal & pelvic (abdominopelvic)
Term for external genitalia
Perineum
What's the orientation of the pelvis, which is sometimes contrary to popular belief?
Tipped forwards, so anterior superior iliac spine & pubic tubercle are on same vertical plane
Since the pelvis is tipped forwards in orientation, what 2 landmarks are located on the same vertical plane?
Anterior superior iliac spine & pubic tuburcle
What components of the pelvis really help with stability, allowing the transfer of weight of the upper body to the limbs?
Pelvic ligaments
Besides connecting pelvic bones together, what else do the ligaments & muscles of the pelvis do?
Form openings to transmit nerves, vessels, & muscles
The inguinal ligament forms an opening for what?
Femoral nerve/vessels to anterior thigh
The greater sciatic foramen forms an opening for what?
Gluteal nerves/vessels
The obturator canal forms an opening for what?
Medial thigh nerves/vessels
How does the pudendal nerve travel through the pelvis, and where does it go to innervate?
Greater sciatic foramen - lesser sciatic foramen - perineal region beneath pelvic outlet
1. All pelvic muscles discussed in lecture are innervated by what type of nerves?
2. Where do the nerves come from?
1. Somatic
2. Sacral plexus along posterior wall of bony pelvis
The sacral plexus, which innervates the pelvis, also innervates what?
Skeletal muscle & sensory to skin of gluteal/perineal regions & leg/posterior thigh
Where does the sacral plexus originate from?
L4-S4
Does the sacral plexus innervate reproductive organs?
No (except for parts exiting pelvis)
On the bottom end of the pelvis (pelvic outlet), what muscles closes it off?
Pelvic diaphragm
Separates the pelvic cavity from the perineum & covers pelvic outlet
Pelvic diaphragm
What shape is the pelvic diaphragm?
Funnel-shaped
2 muscles that make up the pelvic diaphragm
Levator ani & coccygeus
Helps maintain closure of the rectum
Levator ani
The gap that is anterior to the anorectal junction; urethra & vagina pass thru
Urogenital hiatus (in levator ani)
What is the urogenital hiatus filled by?
-Perineal membrane
-Urethra
-Vagina (female)
What's the anal aperture filled by?
Rectum
Forms sling around rectum to act as a sphincter
Pelvic diaphragm
Supports bladder, uterus, vagina, & rectum
Pelvic diaphragm
What functions does the pelvic diaphragm serve?
-Organ support
-Increase intra-abdominal pressure
-Urination/defecation
-Pregnancy/labor
-Kegel exercises
Kegel exercises strengthen what muscle to prevent organ prolapse?
Pelvic diaphragm
This refers to the peritoneum's contour, draping like a sheet over furniture (organs); the pelvic peritoneal lining is continuous with the peritoneum
Peritoneal reflections
1. What does the peritoneal reflections form?
2. Where in women & how many?
3. Where in men & how many?
1. Pouches
2. 2 - recto-uterine & vesico-uterine pouches
3. 1 - recto-vesical pouch
Why was the vesico-uterine pouch particularly important for surgery pre-laparoscopy?
Provided a portal for certain procedures
"Packing material" for pelvic organs; between peritoneum & pelvic diaphragm
Subperitoneal fascia
What are thickenings in the subperitoneal fascia called?
Ligaments (support pelvic organs)
This ligament passively supports the uterus
Transverse cardinal ligament
How do blood vessels travel to the pelvic organs?
From lateral wall through subperitoneal fascia
What is this picture highlighting?
Pelvic diaphragm (2nd layer of pelvis)
What is this picture highlighting?
Subperitoneal connective tissue (3rd layer of pelvis)
What is this picture highlighting?
Peritoneum (4th layer of pelvis)
Diamond-shaped region enclosed by the boundaries of the pelvic outlet & below pelvic diaphragm
Perineum
1. The perineum is divided into how many triangles?
2. What are their names?
1. 2
2. Urogenital triangle (superior) & anal triangle (inferior)
Are the urogenital & anal triangles in one plane or a different plane?
Almost at right angles to one another (not in one plane)
Key structure in the urogenital triangle; supports structures that compose external genitalia
Perineal membrane
The perineal membrane organizes the urogenital triangle into what 2 pouches?
Superficial & deep
The superficial pouch of the urogenital triangle of the perineal membrane contains what?
External genitalia
The deep pouch of the urogenital triangle of the perineal membrane contains what?
-Sphincters for urethra (external) & vagina (female)
-Urethra penetrates
What is a key difference between the urogenital & anal triangles of the perineal membrane?
The UG triangle isn't an open space between pelvic diaphragm & skin
The erectile tissues (clitoris, glans penis) & bartholin's glands (women) are contained in what area?
Superficial pouch of UG triangle (perineal membrane)
Central tendon of the perineum; "center of things" at junction of UG & anal triangles (perineum)
Perineal body
Anchoring point for levator ani/perineal muscles (i.e. sphincters for urethra/vagina/anus), so very important for maintaining tone & integrity for pelvic organs
Perineal body (central tendon at junction of UG & anal triangles)
1. Is the anal triangle open or closed?
2. Is it covered by membrane?
1. Open
2. No - no perineal membrane or pouches
What 2 things comprise the anal triangle?
-External anal sphincter
-Ischioanal fossae
This part of the anal triangle (perineal membrane) is a site of infection & may result in abscesses & these may rupture
Ischioanal fossae (yellow part)
Are the superficial fascias of the abdomen & UG triangle continuous?
Yes
In the event of a urethral rupture, will urine collect inside the anal triangle or upper leg?
No - these are not continuous w/perineal pouches
What hormone permits greater rotation of the pelvis during childbirth?
Relaxin
What angle change in the back occurs during pregnancy?
Increased lordosis
What part of the pelvis permits a 10-15% diameter increase (transverse) during labor?
Pubic symphysis
What can cause pain in the lower limbs for a mother giving birth?
Head compresses sacral plexus
1. Major nerve of the perineum?
2. Origination?
3. What opening does it exit pelvis?
4. What opening does it enter pelvis?
1. Pudendal nerve (somatic)
2. Sacral plexus
3. Greater sciatic foramen
4. Lesser sciatic foramen
Only blocks sensation of perineum; less common with widespread use of epidural
Pudendal nerve block
This muscle most often torn in childbirth
Pubococcygeus (part of levator ani)
Why is incontinence a common risk associated with childbirth?
Weakening of levator ani & pelvic fascia from stretching/tearing may alter position of bladder neck & urethra
What comprises the "bony pelvis"?
2 pelvic (hip) bones & sacrum
What's the most amazing role of the bony pelvis?
Role as the birth canal during labor
What 3 bones form the hip?
-Ilium
-Ischium (blue)
-Pubis
The 3 hip bones meet up to form the socket for the femur head. What's the socket's name?
Acetabulum
Know common landmarks
...
Know common landmarks
...
What differentiates the false (greater) pelvis from the true (lesser) pelvis?
False (between iliac bones) contains GI organs; true (between ischium & pubis) contains bladder/uterus
Important bony landmark; junction of ABD & pelvic cavities & false/true pelvis
Pelvic Brim
The false pelvis is considered part of what region?
Abdomen
"Entrance" to true pelvis & pelvic cavity proper
Pelvic Brim
Describe the depth & diameter of the pelvis for a male in comparison with a female
Male: Deep & narrow
Female: Shallow & wide
Describe the thickness & weight of pelvic bone for a male in comparison with a female
Male: Thick & heavy
Female: Thin & light
The sacrospinous & sacrotuberous ligaments turn the greater & lesser sciatic notches into foramen. Which is the larger & more superficial of the 2?
Sacrotuberous ligament
With the exception of the perineum & inferior part of vagina, which are innervated by the pudendal nerve of the sacral plexus, the reproductive organs are innervated by what type of nerves?
Autonomic nerves
How do the ovaries generally ovulate?
Alternate 1 egg/month
Part of broad ligament that suspends ovaries
Mesovarium (of broad ligament)
Where do ovaries receive their blood from?
Abdomen (via internal iliac)
Are the ovaries covered by peritoneum?
No - so that eggs are accessible to be picked up at end of uterine tube
Another term for uterine tubes
Oviducts
What lines the inside of the uterine tubes? What's the function?
Cilia - to move egg along
The funnel-shaped and distal end of the uterine tube is called this
Infundibulum
What are the projections at the distal end of the uterine tube (infundibulum) called?
Fimbria
Longest part of uterine tube; site of fertilization
Ampulla
Ampulla of uterine tube narrows to form this at the junction w/uterus
Isthmus
1. Why can infections spread fairly easily between uterus, vagina, and ABD organs?
2. What are some examples?
1. Oviducts (uterine tubes) open to peritoneal cavity - this is a 2-way street to abdomen
2. PID & STD's - PID can lead to peritonitis & vice versa
Most common site of ectopic pregnancies
Uterine tubes
What's the problem with ectopic pregnancies?
Rarely viable & life-threatening to mother (tubal rupture & hemorrhage)
Pear-shaped organ with thick wall of smooth muscle
Uterus
What are the 3 parts of the uterus?
Top: Fundus
Middle: Body
Bottom: Cervix
Grows every month in preparation for implantation; sheds if no embryo implants
Endometrial lining
Dome-shaped inferior part of uterus; extends into vagina
Cervix
As the cervix extends into the vagina, it forms gutters called
Fornices
Explain 3 different times the uterine muscle length changes, and give those general lengths (i.e. short, medium, long)
During menstruation - medium (80cm)
After menstruation - short (40cm)
Up to 10x longer in pregnancy (to expel fetus)
How would you describe the position of the uterus?
Head - fundus
Body - body
Legs - cervix
What are the 2 axes for describing uterine position?
-Angle of anteflexion (between cervix & uterine body)
-Angle of anteversion (between vagina & cervix
What are some abnormal uterine positions?
-Retroflexed
-Retroverted
-Prolapsed
Uterus can grow __1__ times its weight & increase its muscle fiber length by __2__ times; postpartum weight loss of 50% by __3__ weeks
1. 45
2. 10
3. 4
What helps suppress estrogen secretion & stimulate oxytocin to contract myometrium postpartum?
Breastfeeding
What do the ovarian, uterine, & vaginal arteries do during pregnancy (very important)?
Anastomose
What do pap smears aid in screening for?
Cervical cancer
Cervical dysplasia isn't cancer, but it's a risk factor for developing it. What's a common cause of cervical dysplasia?
HPV
What site is used when doing a pap smear?
Mucosa outside and inside of cervical canal
What aids in reducing the risk of pathogenic growth in the vagina?
Vaginal lining cells secrete glycogen, which is fermented into acid by resident bacteria, keeping pH acidic (3.5-4)
What's the pH of the vagina?
3.5-4
What's the most common vaginal infection?
Yeast vaginitis
What are 2 names for the female external genitalia?
Vulva or pudendum
The units within the testes that produce sperm & hormones
Seminiferous tubules
Sperm collects in tubes that lead to what?
Epididymis
Where do sperm mature?
First part of epididymis - head & body
Once mature, sperm leave the epididymis via what tube?
Ductus deferens
How long does it take for sperm to mature, and thus reach the tail of the epididymis?
20 days
How does ejaculation cause release of sperm?
SNS innervates lower part of tail of epididymis, causing intense contractions during ejaculation
How long do sperm remain fertile for?
40-60 days
Where do testes develop?
ABD cavity & descend (inguinal canal) during fetal development
What does the spermatic cord descend thru, and what is contained within it?
Inguinal canal - ductus deferens & blood vessels/nerves/lymph
What is the anatomical equivalent of the labia majora in males? What's the major difference?
Scrotum; it holds gonads, whereas in females the labia majora doesn't
What are the 3 mechanisms for regulating the 35 degree temperature of the testes?
-Dartos muscle
-Cremaster muscle
-Pampiniform plexus
In the fascia of the skin; contracts & wrinkles skin to hold testes closer to the body & reduce heat loss
Dartos muscle
Covering of the spermatic cord; contracts to draw testis closer to body (warmth) or relaxes when it gets too warm
Cremaster muscle
Extensive web of testicular veins leaving testis that wrap around incoming testicular artery in spermatic cord; act as countercurrent heat exchanger; as testicular artery bring blood that's warmer than venous blood, that heat transfers to testicular veins
Pampiniform plexus
What's the most common type of hernia?
Inguinal
Through inguinal canal (deep ring); 2/3 of hernias
Indirect inguinal hernia
Medial part of inguinal canal through weakness in wall; includes peritoneal sac with intestine or fat; 1/3 of hernias
Direct inguinal hernia
Which type of hernia is often acquired, and what population is it more common in?
Direct - older men (hasselbach's triangle)
Which type of hernia is much more frequent in both males & females?
Indirect
How long is the ductus (vas) deferens?
18" - the spinal cord!
Where do the ductus (vas) deferens start, and where do they travel from there (until the end)?
Tail of epididymis - ascends in spermatic cord thru inguinal canal - crosses external iliac vessels - crosses ureter - forms ejaculatory duct w/duct of seminal vesicle - opens to prostatic urethra
What do the ductus deferens join with to form the ejaculatory duct?
Ducts of seminal vesicles
For someone who's had a vasectomy, what fluid comprises the ejaculate?
Fluid from seminal vesicles, prostate, & bulbourethral glands (no sperm)
Accessory glands that joins ductus deferens to form ejaculatory duct
Seminal vesicles
Produces alkaline fluid w/fructose as an energy source for sperm; 70% of ejaculate volume
Seminal vesicles
Know the following locations on the picture on reverse side (listed in order of flow):
-Ampulla of ductus deferens
-Seminal vesicle
-Prostate
-Prostatic urethra
-Membranous urethra
-Spongy urethra
-Ampulla is tube portion beside seminal vesicle (looks like leaf)
-Prostate is chestnut shaped gland below bladder
-Prostatic urethra is portion inside of prostate
-Membraneous urethra is between prostatic & penile spongy tissue (spongy urethra)
What is the connection of reproductive & urinary tracts in men?
Prostate
What's important in relation to the drainage of the prostate for disease determination?
Metastasis of prostate cancer
This gland produces thin milky fluid; 30% of semen
Prostate
Prostatic zones:
Which zone is r/t BPH?
Transitional zone (TZ)
Prostatic zones:
Which zone is r/t cancer?
Peripheral zone (PZ)
2nd most common cancer in men
Prostate cancer
Where does prostatic cancer metastasize to?
Pelvic lymph nodes (internal iliac/sacral) - then rest of body
Foreskin of the penis
Prepuce
Expanded end of penis w/urethral opening
Glans
Muscles of penile root; attached to ischipubic rami
Crura (crus of penis)
Is body of penis attached to anything? If, so, what is it?
No attachment - free hanging
Arteries responsible for either leaking to cause erection of penis or not leaking & communicating directly w/draining veins when penis is flaccid
Helicine arteries
A couple of bacterial STD's which may present w/no symptoms
Gonorrhea, chlamydia
What's the risk of untreated STD's in women? Men?
Women: PID - infertility
Men: Infertility
*Especially chlamydia & gonorrhea
2 most common STD's
Chlamydia & gonorrhea
Trace route of sperm from testes to exiting urethra via glans penis
Epididymis - ductus (vas) deferens - ejaculatory duct - urethra (3 sections)
What 2 glands input approximately 90% of seminal fluid?
Seminal vesicles (60%) & prostate (30%)
What must happen to a sperm in order for it to fertilize an egg?
It must be capacitated (membrane alteration)
Term referring to fertilized egg being transported to the uterine cavity
Blastocyst