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UGS Anatomy 2

Urogenital System Anatomy- Reproductive System

QuestionAnswer
What are the excretory ducts of the male reproductive system? The epididymis, the ductus deferens, and the ejaculatory duct on either side
What are the accessory glands of the male reproductive system? The seminal vesicles, the bulbourethral glands, and the prostate gland
What are the constituents of the spermatic cord? Ductus deferens Testicular artery Pampiniform plexus of veins which collects into the testicular vein Artery of vas deferens Cremasteric artery Genital branch of genitofemoral n. Lymphatics of testis and epididymis Plexus of sympathetic n
Where is the artery of the vas deferens derived from? The inferior vesical artery
Where is the cremasteric artery derived from? The inferior epigastric artery
What are the 3 coverings of the spermatic cord? 1) Internal Spermatic fascia 2) Cremasteric fascia 3) External spermatic fascia
Where is the internal spermatic fascia derived from? Fascia transversalis
Where is the cremasteric fascia derived from? Internal Oblique and Transversus Abdominus
Where is the external spermatic fascia derived from? From the external oblique aponeurosis
How much of the spermatic cord does the internal spermatic fascia cover? It covers the cord along its whole length
How much of the spermatic cord does the cremasteric fascia cover? Covers the cord below the level of the internal oblique and transversus abdominus
How much of the spermatic cord does the external spermatic fascia cover? The cord below the superficial inguinal ring
What do the testes produce? Spermatozoa, male germ cells, male sex hormones, and androgens
Where are the testes situated? In the scrotum
What is the location of the testes in early fetal life? The abdominal cavity near the kidneys
How do the testes descend into the scrotum? Via the inguinal canal
Spermatogenesis can only take place normally if the testes are lower than what? The abdominal cavity
Each testis has a thick fibrous capsule called: The Tunica albuginea
When the tunica albuginea thickens posteriorly, it forms: The mediastinum testis
The inner surface of the capsule to the mediastinum are divided into how many lobules? And by what? 250 lobules by fibrous septa
How many seminiferous tubules are contained in each lobule? 1-3
What is the form of each seminiferous tubule? Loop form with each continuous with a straight tubule
The straight tubules open into a network of channels within the mediastinum testis called The rete testis
Where are the polyhedral interstital cells that produce male sex hormones? Delicate connective tissue between the seminiferous lobules
Where are the rete testis drained into? The epididymis via the efferent ductules
What is the length of each seminiferous tubule? 2 feet
The seminiferous tubules of each lobule drain into the straight tubules called: tubuli recti or vasa recta
From the upper part of the rete testis how many short ducts arise? 15-20
The short ducts which arise from the upper part of the rete testis are called: Efferent ductules/ Vasa efferentia
Where do the vasa efferentia unite to form a single duct? The head of the epididymis
What is the duct formed by the vasa efferentia called? The duct of the epididymis
What is the order of tubules in the testes? Seminiferous tubules -->Tubuli recti/Vasa recta --> Rete testis --> Vasa efferentia --> Duct of epididymis
What are the three main mechanisms for regulation of the functions of the testes? 1- Hypothalmic control 2- Anterior pituitary control 3- Negative feedback control
How does the hypothalamus participate in the regulation of the testes? Arcuate nuclei of the hypothalamus secrete GnRH into hypophysial-portal blood GnRH stimulates the anterior pituitary to release FSH and LH
How does the anterior pituitary participate in the regulation of the testes? It releases FSH and LH FSH acts on the Sertoli cells to maintain spermatogenesis LH acts on the Leydig cells to promote testosterone synthesis
How does negative feedback participate in the regulation of the testes? Testosterone directly inhibits the hypothalamus from producing GnRH and directly inhibits release of LH from the anterior pituitary Inhibin produced by Sertoli cells inhibits FSH secretion from the anterior pituitary
How long is the duct of the epididymis? 20 feet or 6 meters
What are the parts of the epididymis? The large upper part or head The middle part or body The lower end or tail
Which structure rises from the tail of the epididymis? The ductus deferens
Where does the epididymis lie in relation to the testes? The epididymis lies on the posterior border of the testes
Where does the vas deferens travel after arising from the tail of the epididymis? It ascends on the posterior border of the testes medial to the epididymis
What is the primary location for maturation and storage of sperms? The epididymis
How long do the sperm remain viable in the epididymis for? Months
What other location functions in the storage of sperm? The ampulla of the ductus deferens
The lobules of the epididymis are made up of: Efferent ductules held together by loose connective tissue
What is contained in the lumen of the duct of the epididymis? Spermatozoa
What is the type of epithelium in the duct of the epididymis? Pseudostratified columnar epithelium The epithelium is separated by a basement membrane from the connective tissue wall which has smooth muscle cells
Describe the histology of the duct of the epididymis: Basal cells which have round nuclei Principal cells which have oval nuclei The principal cells have extremely long microvilli called stereocilia
What is the shape of the smooth muscle in the duct of the epididymis? Smooth muscle cells are circular in the head and multidirectional in the tail
What are the functions of the duct of the epididymis? 1) Absorption of fluid by the long microvilli 2) Storage and maturation of spermatozoa 3) Phagocytosis
The front and sides of the testis is covered by: The visceral layer of the tunica vaginalis
What is the sinus of the epididymis? The part of the tunica vaginalis invaginated between the testis and the epididymis
What is the ductus deferens? A thick-walled tube which transmits spermatozoa from the epididymis to the prostatic urethra via the ejaculatory duct
How long is the ductus deferens? 18 inches or 45 cm
The Ductus deferens has a narrow lumen throughout all of it except at the: Terminal ampulla
What is the epithelium of the vas deferens? Pseudostratified columnar epithelium with sterocilia and lamina propria
The mucosa of the vas deferens forms: Longitudinal folds
How many layers make up the musculosa of the vas deferens? 3 - Inner longitudinal - Middle circular- Outer longitudinal
What is the adventitia of the vas deferens made up of? Thick connective tissue
What is the importance of the adventitia of the vas deferens? Support of blood vessels and nerves
What is the course of the ductus deferens? 1) On the posterior border of the testis 2) In the spermatic cord which traverses the inguinal canal 3) In the greater pelvis 4) In the lesser pelvis
What vessels does the ductus deferens cross in its path? 1) At the deep inguinal ring --> hooks around the lateral part of the inferior epigastric artery 2) Before the lesser pelvis it crosses the external iliac vessels 3) On the lateral pelvic wall, it crosses the obturator nerve and vessels
When the ductus deferens passes on the base of the bladder, it is in contact with: The medial side of the seminal vesicles
When does the ampulla of the vas deferens form? When the ductus deferens is in contact with the medial side of the seminal vesicles
Where does the vas deferens join the seminal vesicles to form the ejaculatory duct? Behind the neck of the bladder
The artery to the ductus deferens is derived from: The superior or inferior vesical arteries
The artery to the ductus deferens anastomoses with: The testicular artery
How does the ductus deferens convey sperm? Via peristalsis
Why is peristalsis of the ductus deferens possible? Because the smooth muscle fibers are richly supplied by sympathetic nerves
What is the prostate? An accessory gland of the male reproductive system which adds to the bulk of the seminal fluid
What is the shape and consistency of the prostate? Conical and firm
Where is the position of the prostate? It lies below the neck of the urinary bladder, surrounding the commencement of the male urethra Behind the lower part of the pubic symphysis and upper part of the pubic arch In front of the ampulla of the rectum
The firmness of the prostate is due to: Dense fibromuscular stroma in which the complex glandular acini are embedded
What are the types of glands in the prostate? Tubulo alveolar
The glands of the prostate open into the: Prostatic sinuses on either side of the urethral crest
What is the difference in the glands on the outer and inner zone of the prostate? At the periphery, these glands are large and branches At the inner zone, there are smaller mucosal and submucous glands
Describe the epithelium of the glands of the prostate. Generally, The epithelium of the glands is columnar and shows papillary elevations In reality, the epithelium vary from inactive low cuboidal to active pseudostratified columnar depending on the degree of stimulation by androgens
The ducts of the prostate are lined by 2 layers of what kind of epithelium: Inner columnar layer and outer cuboidal layer
The lumen forms amorphous masses called: Corpora Amylacea
What happens to the corpora amylacea with age? They are progressively calcified into prostatic salts
What are the dimensions of the prostate? 4 cm transversely at the base 3 cm vertically 2 cm anteroposteriorly
How much does the prostate weigh? 8g
The prostate has what characteristics? 1) A downwards apex 2) A base 3) 4 surfaces 4) Five lobes
What are the relations of the apex of the prostate? It rests on the upper surface of the urogenital diaphragm It is separated from the anal canal by the perineal body
What are the relations of the base of the prostate? It is directed upwards It is continuous with the neck of the bladder Marked by a circular groove which lodges veins of the vesical and prostatic plexuses
What are the surfaces of the prostate? 1) Anterior surface 2) Posterior surface 3) 2 inferolateral surfaces
Describe the anterior surface of the prostate: It is narrow and convex It lies 2 cm behind the pubic symphysis separated by retropubic fat
The upper anterior surface of the prostate is connected to pubic bones by: Puboprostatic ligaments
The lower anterior surface of the prostate is pierced by: The urethra
Describe the posterior surface of the prostate: Triangular Convex from up downwards Can be easily palpated on digital examination through the rectum
What are the relations of the posterior surface of the prostate? 1) Separated from the rectum by the fascia of Denonvillers 2) Near its upper border, it is pierced on either side by the ejaculatory duct 3) 4 cm from the anus
Describe the 2 inferolateral surfaces of the prostate: Convex and are supported by the anterior fibers of the levator ani Separated by a plexus of veins embedded in its sheath
What are the 5 lobes of the prostate? 1) Anterior lobe 2) Posterior lobe 3) Median lobe 4) 2 Lateral lobes
Which structures divide the lobes of the prostate? The ejaculatory ducts and urethra
Describe the anterior lobe of the prostate: Small isthmus Connects the two lateral lobes Little to no glandular tissue --> seldom forms adenomas
Describe the posterior lobe of the prostate: Connects the two lateral lobes behind the urethra Lies behind the median lobes and ejaculatory ducts Adenoma never occurs, but primary carcinomas can
Describe the median lobe of the prostate: Lies behind the upper urethra In front of the ejaculatory ducts, just below the neck of the bladder Produces an elevation in the trigone --> uvula vesicae Plenty glandular tissue -->adenoma
Describe the lateral lobes of the prostate: Lies on each side of the urethra Contains enough glandular tissue to form an adenoma in old age
What are the capsules of the prostate? 1) True capsule 2) False capsule 3) Surgical capsule
Describe the true capsule of the prostate Fibromuscular in structure and continuous with the stroma of the gland Lies deep to the false capsule
How is the true capsule of the prostate formed? By the condensation of the peripheral part of the gland
Describe the false capsule of the prostate It lies outer to the true capsule Formed by the retrovescial fascia of Denonvilliers
The false capsule of the prostate is derived from: The lower, obliterated part of the retrovesical pouch which separated the prostate from the rectum during fetal life
What are the relations of the false capsule of the prostate? Anteriorly, it is continuous with the puboprostatic ligaments On each side, the prostatic venous plexus is embedded in it Posteriorly, it is avascular
What are the structures in the prostate? 1) Prostatic urethra 2) Prostatic utricle 3) Ejaculatory ducts
What is the relationship between the prostate and the prostatic urethra? Traverses the gland vertically at the junction of the anterior 1/3 with the posterior 2/3
Where does the prostatic utricle open into? The middle of the urethral crest
What are the zones of the prostate? 1) Outer larger zone 2) Inner smaller zone
The zones are absent in which part of the prostate? Anteriorly
The outer zone of the prostate is made up of: Large branched glands Formed by the buds arising from the endoderm of the prostatic urethra
What is the inner zone of the prostate made up of? Submucosal glands and a group of short, simple mucosal glands surrounding the upper part of the urethra Formed by buds arising from the mesoderm of the prostatic urethra
Describe the fluid secreted by the prostate gland: Milky and slightly acidic with a pH of 6.5 The fluid contains zinc, citric acid, phosphatase, and proteolytic enzymes Accounts for one-quarter - one-third of the semen volume
What are the proteolytic enzymes present in the prostatic fluid? PSA. fibrinolysin, amylase, and hyaluronidase
Located inferior to the prostate on either side of the prostatic urethra are: The bulbourethral glands
The ducts of Cowper's glands open into: The spongy/penile urethra
During sexual arousal, what is the function of Cowpers glands? They secrete alkaline fluid to protect passing sperm from being neutralized by acidic urine
Nodular hyperplasia of the prostate arises mostly in: The submucosal and mucosal zones Usually the more medial parts
Carcinomas of the prostate usually arises in: The outer, peripheral zones
What is a potential risk factor for nodular hyperplasia? Age -related increase in esterogen
Why is age-related increase in estrogen a potential risk factor for nodular hyperplasia? It may result in increased expression of DHT receptors on the prostate parenchymal cells
What are the seminal vesicles? Two lobulated sacs
Where are the seminal vesicles located? Between the urinary bladder and the rectum
How long are the seminal vesicles? 2 inches each
The seminal vesicles join the ductus deferens to form: The ejaculatory duct
The mucous membrane of the seminal vesicles is: thrown into many folds and lined by pseudostratified columnar epithelium
The muscular coat of the seminal vesicles are made up of how many layers? 2 An inner circular layer and outer longitudinal --> Opposite to every other muscularis we've discussed so far
The fibrous coat of the seminal vesicles is made up of: Loose CT
Do the seminal vesicles store sperm? No
The alkaline secretions of the seminal vesicles form how much of the seminal fluid? About 60%
The fluid of the seminal vesicles is made up of: Fructose, citrate, prostaglandins, and fibrinogen
How do prostaglandins assist in fertilization? 1) React with cervical mucous to make it more penetratable 2) Induce peristalsis in the female reproductive tract to propel sperm to the fallopian tubes
The seminal vesicles are controlled by Testosterone
What is the perineal body and where is it located? It is a fibromuscular node situated on the median plane, 1.25cm in front of the anal margin and close to the bulb of the penis
Which types of muscles interlace in the perineal body? 3 unpaired muscles and 3 paired
What are the 3 unpaired muscles which interlace in the perineal body? 1) External anal sphincter 2) Bulbospongiosus 3) Unstriped fibres of the longitudinal muscle coat of rectal ampulla and anal canal
What are the 3 paired muscles which interlace in the perineal body? 1) Superficial transversus perinei 2) Deep transversus perinei 3) Levator ani
What is the shape of the perineum? Diamond-shaped
What are the boundaries of the perineum in males? Anteriorly: Scrotum Posteriorly: Buttocks On each side: Upper part of the medial side of the thigh
What are the deep boundaries of the perineum in males? Anterior: Arcuate/ inferior pubic ligaments Posterior: Tip of coccyx On either side: Ischio-pubic rami, ischial tuberoscity, and sacrotuberous ligament
What are the components of the female reproductive system? A pair of ovaries, a pair of uterine tubes, a uterus, vagina, and external genitalia
What is the uterus? A hollow, yet thick-walled, firm organ in females situated between the bladder and the rectum
How can the uterus be palpated? During a per vaginum (PV) exam
What are the dimensions of the uterus? 3 inches in length, 2 inches in width, and 1 inch thick
How much does the uterus weigh? 30-40 g
What is the shape of the uterus? Piriform Flattened from before backwards
The upper expanded two-thirds of the uterus is: The body
The lower cylindrical third of the uterus is: The cervix
The circular constriction between the body and the cervix is: The external os
What is the isthmus of the uterus? The constriction of the upper 1/3rd of the cervix
The upper third of the cervix is called the: Lower uterine segment
Why is the upper third of the cervix called the lower uterine segment? Because it is taken up into the body during the second month of pregnancy
During labor, the lower segment of the uterus forms: The conducting part of the uterus and becomes stretched and elongated
During labor, the upper segment of the uterus forms: The propulsive part
Normally what is the direction of the uterus? Anteverted and Anteflexed
Forward angulation between the cervix and vagina is called: The angle of anteversion (90 degrees)
The slight forward angulation between the body and cervix is called: The angle of anteflexion (120-125 degrees)
The long axis of the uterus corresponds to the axis of: The pelvic inlet
The axis of the vagina corresponds to: the axes of the pelvic cavity and outlet
The body of the uterus is made up of which parts? 1) Fundus 2) Two surfaces 3) Two lateral surfaces
What are the 2 surfaces of the uterus? Anterior/Vesical and Posterior/Intestinal
What is the shape of the fundus of the uterus? Convex like a dome
What are the peritoneal relations of the fundus? It is covered with peritoneum
When the bladder is empty. the fundus is directed: Forwards
The fertilized ovum is implanted in: The posterior wall of the fundus
What is the shape of the anterior/vesical surface of the uterus? Flat
The anterior surface of the uterus is related to: The urinary bladder
The anterior surface of the uterus forms which peritoneal structure? The posterior/superior wall of the vesicouterine pouch It is also covered with peritoneum
What is the shape of the posterior/intestinal surface of the uterus? Convex
The posterior surface of the uterus is related to: The terminal coils of the ileum and sigmoid colon
Which peritoneal structure is formed from the posterior surface of the uterus? The anterior wall of the rectouterine pouch It is also covered with peritoneum
What is the shape of the lateral borders of the uterus? Rounded and convex
What is the purpose of the lateral borders of the uterus? It provides attachment to the broad ligament of the uterus which extends to the lateral pelvic wall
At the upper ends of the lateral borders of the uterus, what opens? Uterine tubes
Anteroinferior to the uterine tube, what ligament is attached? The round ligament
Posteroinferior to the uterine tube, what ligament is attached? The ligament of the ovary
The uterine artery ascends along the lateral border of the uterus between: The two layers of the broad ligament
How long is the cervix of the uterus? 1 inch long
The lower part of the cervix projects into: The anterior wall of the vagina This divides it into the supravaginal and vaginal parts
What are the relations of the supravaginal part of the cervix? Anterior: Bladder Posterior: Rectouterine pouch with intestinal coils and the rectum On each side: the ureter and uterine artery embedded in parametrium
What is the parametrium? The fibrous fatty tissue between the two layers of the broad ligament and below it
The parametrium is most abundant: Near the cervix and vagina
The vaginal part of the cervix projects into the anterior wall of the vagina forming: The vaginal fornices
The cervical canal opens into the vagina via the: External os
In a nulliparous woman, the external os is: Slit-like and transverse with small rounded lips
In a multiparous woman, the external os is: Wide and the lips are irregular
The external os has anterior and posterior lips which are normally in contact with: The posterior vaginal wall
What is the shape of the cervical canal? Fusiform Flattened from before backwards
What are the communications of the cervical canal? Above: with the uterine canal though the internal os Below: with the vaginal cavity through the external os
Describe the mucosal folds in the anterior and posterior walls of the cervical canals: They resemble the branches of a tree and are called arbor vitae uteri They interlock and close the canal
What is the epithelial lining of the cervix? Tall columnar cells which secrete mucus Some tall ciliated cells
If the vagina has no glands and does not produce mucus, how is it lubricated? It receives mucus from the cervix
When the glands on the lining of the cervix are occluded and filled with secretion, what is formed? Nabothian cysts
The wall of the cervix consists mainly of: Collagenous tissue, elastic fiber, and little SM
The portion of the cervix which protrudes into the vaginal canal is covered by which epithelium? Non-keratinized stratified squamous epithelium
Where is the junction between the simple columnar epithelium and stratified squamous epithelium in the cervix/vagina? Just within the external os
What are the communications of the uterus? Superiorly, on each side, it communicates with the uterine tubes Inferiorly, it communicates with the vagina
What are the broad ligaments? Two folds of peritoneum which suspend the uterus to the lateral pelvic wall
When the bladder is full, what are the sides of the broad ligament? 1) Anterior surface 2) Posterior surface 3) Free upper border 4) Inferior, medial and lateral borders
What are the inferior, medial, and lateral borders of the broad ligament attached to? The pelvic floor, the uterus, and the lateral pelvic wall respectively
The broad ligament is divided into what portions? 1) Mesosalpinx 2) Mesometrium 3) Infundibulopelvic ligament 4) Mesovarium
The mesosalpinx lies between which structures? The uterine tube and the ovary (ovarian ligament)
Where does the mesometrium lie? Below the ovarian ligament Connects the lateral wall of the uterus to the pelvic wall
Where does the infundibulopelvic ligament lie? It is the lateral 1/5th of the broad ligament It extends from the tubal end of the ovary to the lateral pelvic wall
Where does the mesovarium lie? Between the mesometrium and mesosalpinx It suspends the ovaries
What structures lies within the mesometrium? Ureters
What structures lie within the infundibulopelvic ligament? The ovarian vessels and nerves
What structures lie within the mesovarium? Ovary and ovarian ligaments
What lies in the free upper border of the broad ligament? The uterine artery
What are the general components of the broad ligaments? 1) One tube 2) Two ligaments 3) Two vessels 4) Two nerves 5) Two embryological remnants 6) Two misc. structures
What is the tube of the broad ligament? The uterine tube in the free upper border
What are the 2 ligaments of the broad ligament? 1) The round ligament of the uterus buldges out of the anterior layer 2) Ligament of ovary bulges out the posterior layer
What are the 2 vessels of the broad ligament? 1) Uterine vessels 2) Ovarian vessels in the infundibulopevic ligament
What are the 2 nerves of the broad ligament? 1) Uterovaginal plexus 2) Ovarian plexus
What are the two embryological remnants of the broad ligaments? 1) Epoophoron and its duct (Gartners duct) 2) Paroophoron
What are the two miscallaneous structures in the broad ligament? 1) Lymphatics and nodes 2) Fibroareolar tissue or parametrium
How long are the smooth muscle cells in the non-pregnant uterus? 50 microns
How long are the smooth muscle cells in the pregnant uterus? 500-600 microns
Are new smooth muscle cells produced in the pregnant uterus? Yes
Does the connective tissue of the myometrium increase during pregnancy? Yes
What happens to the layers of the uterus during pregnancy? They are thinned because the uterus becomes distended
After delivery, does the uterus regain its original, non-pregnant dimensions? No
The myometrium normally undergoes intermittent ________ which may increase in intensity during menstruation. Contractions
Why are the contractions of the myometrium diminished during pregnancy? Possibly due to the hormone, relaxin
Uterine contractions at the time of labor increase in response to: Increased oxytocin and prostaglandins
How is oxytocin produced? It is synthesized by neurons forming the supraoptic and paraventricular nuclei of the hypothalamus and released by the neurohypophysis
What are the layers of the uterine wall? 1) Endometrium/Internal lining/mucosa 2) Myometrium/Musculosa 3) Perimetrium/External layer/Serosa
What is the perimetrium? A layer of squamous mesothelial cells resting on areolar tissue
What is the myometrium composed of? Thick smooth muscle and connective tissue layer where the muscular fibers interlace in many directions
How can we distinguish between the internal, middle, and outer layers of SM in the myometrium? The internal layer is thin and consists of longitudinal and circularly arranged SM cells The middle layer is the thickest and shows no regularity in the arrangement of SM cells The outer layer is also longitudinal but has prominent elastic fibers
What makes the middle layer of SM in the myometrium irregular? The cells run longitudinally, obliquely, circular, and transverse Also, this layer contains many large blood vessels (called the stratum vasculare)
Which layer of the uterine wall undergoes cyclic changes? Endometrium
When does the cyclic activity in females begin and when does it end? It begins at puberty and ends at menopause
The endometrium of the uterus consists of : Lamina propria (endometrial stroma) and a covering epithelium
The stroma of the endometrium of the uterus consists of: Loosely arranged stellate cells with large, round, or ovoid nuclei supported by a network of fine CT where WBCs and macrophages are scattered
The stroma of the endometrium of the uterus is covered by: Simple columnar epithelium that contains ciliated cells and nonciliated secretory cells
The epithelium of the endometrium dips into the stroma to form: Uterine glands that extend into the stroma and possibly the myometrium
What are the types of glands formed by the epithelium of the endometrium? Mostly, simple tubular glands, but some branch near the muscle
What underlies the glandular and surface epithelia? A basement membrane
The endometrium can be divided into 2 layers; A stratum basale and stratum functionale
What is the differencebetween the 2 layers of the endometrium? The stratum basale is narrower, ore cellular,and more fibrous It also lies directly on the myometrium This layer does not shed at menstruation The stratum functional extends to the lumen of the uterus and is part of the endometrium
The stratum functionale can be subdivided into: 1) Compacta/ a narrow superficial zone 2) Spongiosa/ broader zone that forms the bulk of it
What is the blood supply of the endometrium? Branches of the uterine artery which divide into arcuate arteries (for the myometrium) and radial arteries for the endometrium
Is there a difference between the blood supply of the stratum basale and functionale? Straight arteries supply the basale and highly coiled arteries supply the functionale
As highly coiled arteries pass through the functional layer, they provide terminal arterioles. What do these arterioles unite with? A network of capillaries and the lacuna (thin walled, dilated vascular structures)
The venous system of the endometrium drains into: A plexus at the junction of the myometrium and endometrium
The venous system of the endometrium forms: An irregular network of venules and veins with irregular sinusoidal enlargements
During menstrual cycles, what happens to the spiral arteries? They constrict periodically subjecting the functional layer to periods of anoxia
What happens to the distal portion of the stratum functionalis during each menstrual cycle? They undergo degeneration
What is the arterial blood supply of the uterus? 1) 2 uterine arteries from the internal iliac arteries 2) Ovarian arteries partly
What is the path of the uterine artery? 1) Medially towards the cervix 2) Crosses the ureter above the lateral fornix of the vagina 2 cm to the cervix 3) Ascends along the side of the uterus tortuously 4) Laterally to the hilum of the ovary and anastomoses with the ovarian artery
What purpose does the tortuousity of the uterine artery serve? It allows the artery to expand during pregnancy
What structures does the uterine artery provide? 1) Uterus via the helicine arties 2) Vagina via ant. or post./azygos arteries of the vagina 3) Medial 2/3 of uterine tubes 4) Ovary 5) Ureter 6) Broad ligament contents
Where does the ovarian artery arise from? The abdominal artery just below the renal artery
What is the path of the ovarian artery? It descends over the posterior abdominal wall and enters te suspensory ligament of the ovary It sends branches to the ovary through the mesovarium and continues medially through the broad ligament of the uterus to anastomose with the uterine artery
What does the ovarian artery supply? 1) The uterine tubes 2) The uterus 3) The ureters
Veins which drain the uterus form a plexus at: The lateral border of the uterus
The plexus which drains the uterus drains through: The uterine, ovarian, and vaginal veins into the internal iliac veins
What are the types of factors which support the uterus? Muscular/ active Fibromuscular/mechanical
What are the muscular supports of the uterus? 1) Pelvic diaphragm 2) Perineal body 3) Urogenital diaphragm
What are the fibromuscular supports of the uterus? 1) Uterine axis 2) Pubocervical ligament 3) Transverse cervical ligament 4) Uterosacral ligament of the pubic symphysis 5) Round ligament of the uterus
What are the protective functions of the pelvic diaphragm? It supports the pelvic viscera and resists a rise in intra abdominal pressure
Why does the tearing of the pubococcygeous part of the levator ani during parturition lead to vaginal and uteral prolapse? The part of the pubococcygeous inserted into the perineal body forms a support and sphincter for the vagina and therefore the uterus and bladder
Which of the vaginal walls are the most poorly supported by the pubococcygeous? The anterior vaginal wall
Which muscles contribute to the efficacy of the levator ani as a support? The perineal muscules which fix the perineal body and anchor the levator ani to it
What physical characteristics of the uterus prevent it from sagging? Its anteverted position which is maintained by the uterosacral and round ligament
Which ligaments make up the transverse cervical ligaments of Mackenrodt? 1) Lateral cervical ligaments 2) Cardinal ligaments 3) Mackenrodt's ligaments 4) Paracervical ligaments 5) Retinacula uteri 6) Sustenaculum of Bonny
What are the transverse cervical ligaments of Mackenrodt? Fan-shaped condensations of pelvic fascia on each side of the cervix above the levator ani and around the uterine vessels
What do the transverse cervical ligaments of Mackenrodt connect to? The lateral aspects of the cervix and upper vaginal wall to the lateral pelvic wall 1 inch ventral to the ischial spine
What is the function of the transverse cervical ligaments of Mackenrodt? They act as a hammock in support of the uterus
What is the length of the anterior vaginal wall? 3 inches or 8 cm
What is the length of the posterior vaginal wall? 4 inches or 10 cm in length
What are the relations of the anterior vaginal wall? The upper half is related to the base of the bladder The lower half is related to the urethra
What are the relations of the posterior vaginal wall? The upper 1/4 is separated from the rectum by the pouch of Douglas The middle 2/4 is separated from the rectum by loose connective tissue The lower 1/4 is separated from the anal canal by the perineal body
What are the relations of the lateral wall of the vagina? Upper 1/3 is related to the transverse cervical ligament and has vaginal veins and ureter crossed by the uterine artery Middle 1/3 --> Pubococcygeous Lower 1/3 -->Pierces the UG diaphragm (below related to bulbospongiosus and bartholin's gland)
Describe the epithelium of the vagina between puberty and menopause: The epithelium is thick and the cells contain plenty of glyocgen giving the cytoplasm a vacuolated appearance
Why does the vagina have a low pH? The surface cells of its epithelium are desquamated and glycogen is liberated and fermented by Doderlein's bacilli which convert it into lactic acid The low pH inhibits pathogenic bacterial growth
What are the layers of the vagina? 1) Mucosa 2) Muscularis 3) Adventitia
The mucosa of the vagina contains folded structures called: Rugae
What type of epithelium is the vaginal mucosa made up of? Non-keratinized stratified squamous epithelium
The lamina propria of the vaginal mucosa is made up of: Dense CT, elastic fibers, and diffuse and nodular lymphatic tissue
What are the layers of the muscularis of the vagina? 1) Inner circular layer 2) Outer longitudinal
The adventita of the vagina consists of: Dense CT and elastic fibers
What is the nerve supply of the vagina? The lower 1/3rd is supplied by the pudendal nerve The upper 2/3rd is supplied by sympathetic L1,L2 and parasympathetic S2,S3 derived as vaginal nerves
What is the difference between sensation in the lower vagina and upper vagina? Lower 1/3rd is pain sensitive and the upper 2/3rd is pain insensitive
The pudendal nerve is derived from: The inferior rectal and posterior labial branches of perineal nerve
The vaginal nerves are derived from: The inferior hypogastric and uterovaginal plexuses
What is the lymph drainage of the vagina? Upper 1/3rd --> external iliac lymph nodes Middle 1/3rd -->Internal iliac lymph nodes Lower 1/3rd -->Medial group of superficial inguinal lymph nodes
How long are the uterine tubes? 10 cm or 4 inches long
What are the diameters throughout the uterine tubes? 3mm at abdominal ostium 4mm at the ampulla 2mm at the isthmus 1mm at the uterine/intramural type
Medially, the tube opens into The superior angle of the uterine cavity by a narrow (1 mm) uterine ostium
What is the shape of the infundibulum of the uterine tube? Trumpet shaped
The infundibulum is made up of: Finer-like processes called fimbriae
What is the ovarian fimbria? The longest, most deeply grooved fimbria which attaches to the tubal pole of the ovary
What are the inner and outer surface linings of the frimbriae of the uterine tubes? The outer surface is covered by peritoneum, but the inner surface is lined by ciliated columnar epithelium
The medial continuation of the infundibulum of the uterine tube is the: ampulla
How much of the uterine tube does the ampulla make up? The lateral 2/3rd
Describe the ampulla of the uterine tube. It is thin-walled, dilated, and arches over the upper pole of the ovary
Which part of the uterine tube succeeds the ampulla? The isthmus
Describe the isthmus of the uterine tube. It is narrow and cord-like
How much of the uterine tube is made up of the isthmus? The medial 1/3rd
How long and how much is the diameter of the uterine part of the uterine tube? 1 cm long and 1 mm in diameter
Where does the intramural part of the uterine tube open into? Into the superior angle of the uterine cavity
The infundibulum projects beyond: The free margin of the broad ligament
What are the layers of the uterine tube? 1) Mucous membrane 2) Serosa 3) Musculosa
How does the uterine tube change in the luteal phase of the ovarian cycle? Decreased height and cilia
How does the uterine tube change in the follicular phase? Increased height of ciliated cells
The mucosa of the oviduct presents a series of longitudinal folds called Plicae
In the ampulla of the oviduct the plicae have Secondary and tertiary folds
What is the difference between the plicae of the intramural oviduct and the isthmus? In the isthmus the plicae are shorter with little branching, while in the intramural part the plicae form only low ridges
The folds or plicae are made up of: Columnar epithelial cells, lamina propria, and undifferentiated cells
The columnar cells of the mucosa of the oviduct can be either: Ciliated or secretory
What are the layers of the mucosa of the uterine tube? Inner circular and outer longitudinal
The serosa of the uterine tube represents: The peritoneal covering
What is the blood supply of the uterine tube? Medial 2/3rd --> Uterine artery from the internal iliac artery Lateral 1/3 -->Ovarian artery
What are the ovaries responsible for? Production of the female germ cells, the ova, and the female sex hormones
What are the dimensions of the ovary? 1.5 x .75 inches Almond-shaped
The ovaries are attached to the broad ligament by the: Mesovarium
What is the difference between nulliparous and multiparous women in the long axis of the ovary? In nulliparous women, its long axis is nearly vertical However, In multiparous women, the long axis becomes horizontal
Each ovary lies in the: Ovarian fossa on the lateral pelvic wall
The ovaries are suspended by: The suspensory ligament of the ovary or Infundibulopelvic ligaments
The ovarian fossa is bound by: Anteriorly: Obliterated umbilical artery Posteriorly: Ureter and internal iliac artery Medially: Uterine Tube
The ovaries are surrounded by a thin, fibrous capsule called the: Tunica albugineas
The tunica albuginea of the ovaries is covered by: A single layer of cuboidal cells called the germinal epithelium
What is the germinal epithelium? A modified area of peritoneum which is continuous with the squamous mesothelial cells of the general peritoneum at the hilus of the ovary
The compact connective tissue stroma of the ovary's cortex is composed of: A network of reticular fibers and spindle shaped cells
The stromal cells of the ovary may be responsible for: Secretion of androgens
Describe the connective tissue stroma of the medulla of the ovaries: It is very vascular and contains elastic fibers and smooth muscle fibers
Where are the ovarian follicles embedded? In the stroma of the cortex of the ovaries
What are the peritoneal relations of the ovaries? Ovary is almost entirely covered with peritoneum, except along the mesovarian (anterior) border
Why isn't the anterior border of the ovary covered with peritoneum? The two layers of the covering peritoneum are reflected on to the posterior layer of the broad ligament of uterus forming the mesovarium
The ovary lies just below and behind which part of the uterine tube? The lateral/ampullary part
What connects the medial margin of the ovary to the lateral wall of the uterus? The round ligament of the ovary
What transmits vessels and nerves to and from the ovaries? The mesovarium
The lateral part of the broad ligament of uterus, extending from the infundibulum of the tube and upper pole of ovary to the external iliac vessels forms: The suspensory ligament of the ovary
Which ligament contains the ovarian vessels and nerves? The suspensory/ Infundibulopelvic ligament
In order to avoid damage to the perineal body during labour, what procedure is performed? Episiotomy
What are the boundaries of the perineum in females? Anteriorly: Mons pubis Posteriorly: Buttocks On each side: Upper part of the medial side of the thigh
What are the deep boundaries of the perineum in females? Anteriorly: Arcuate/ Inferior pubic ligament Posteriorly: Tip of coccyx On either side: conjoned ischio-pubic rami, ischial tuberoscity, and sacrotuberous ligament
What are the divisions of the perineum? Posterior anal triangle Anterior urogenital triangle Divided by a transverse line from the ischial tuberoscities then to the anterior of the anus
What are boundaries of the anal triangle/Ischiorectal fossa? Medial wall: Levator ani and sphincter ani externus Lateral wall: Obturator internus and pudendal canal Base: Skin on the side of the anal canal
What are the contents of the anal triangle? Branches of the pedundal nerve and vessels (inferior rectal nerves and vessels) Anal canal Ano-coccygeal body behind the anal canal
What are the contents of the urogenital triangle? Muscles and fascia forming the urogenital diaphragm Fascia covering the superior surface is the inferior fascia of UG diaphragm
The perineal membrane divides the urogenital region into 2 pouches: Superficial perineal pouch below the membrane Deep perineal pouch above the membrane and towards the pelvic cavity
What is the superficial perineal pouch? The space between the perineal membrane and the membranous layer of superficial fascia (Scarpa’s fascia) of anterior abdominal wall
At the perineum, Scarpa's fascia becomes: Colle's fascia
What are the boundaries of the superficial perineal pouch? Roof: Perineal Membrane Floor: Colle’s Fascia Posteriorly: Closed, roof fused with floor Anteriorly: Space deep to the membranous layer of superficial fascia of the anterior abdominal wall On each side: The sides of the pubic arch/ ischiopubic rami
Which structures pierce the perineal membrane in males and females? The perineal membrane is pierced by the urethra in males, and by the urethra and vagina in females
What are the contents of the superficial perineal pouch in males? Root of penis and associated muscles: this includes the 2 crura and the bulb of the penis
What is the crus of the penis? The posterior part of the corpus cavernosum covered by the ischiocavernosus muscle
What is the bulb of the penis? The posterior part of the corpus spongiosum covered by the bulbospongiosus
What are the contents of the superficial perineal pouch in females? Root of clitoris and associated muscles The clitoris is devoid of urethra It has two crura but its bulb is split by the vagina into 2 parts each (bulb of vestibules)
What are the Contents of the Superficial Perineal Pouch in both sexes? Scrotal nerves in the male and labial nerves in the female Scrotal or labial arteries Terminal branches of internal pudendal artery, of which include the deep artery and dorsal artery of penis
What happens in case of rupture of the spongy urethra? Extravasated urine spreads downward into the superficial perineal space and then the scrotum, penis, and lower part of the anterior abdominal wall
Why doesn't extravasated urine go to the ischiorectal fossa or thigh? Because of the firm attachment of the membranous fascia to their boundaries
What is the Deep perineal pouch? It is a closed space between the perineal membrane below and the superior fascia of the urogenital diaphragm above It is limited on each side by sides of the pubic arch
What are the contents of the deep perineal pouch? Membranous part of urethra 2 bulbourethral glands in male Deep tranverse perinei muscles Dorsal nerve of penis Internal pudendal vessels
Where does the pudendal nerve come from? The sacral plexus S2,3, and 4
The pudendal nerve leaves the pelvis through: The greater sciatic foramen
What is the path of the pudendal nerve after it leaves the pelvis? Crosses the back of the sacrospinous ligament to enter the lesser sciatic foramen where the pudendal canal begins Passes through the pudendal canal in the lateral wall of the ischiorectal fossa where it gives its terminal branches
What branches does the pudendal nerve give? It gives scrotal and labial branches as well as muscular branches to all perineal muscles It also gives the dorsal nerve of the penis or clitoris
How can the pudendal nerve be blocked? With anesthetic The needle is inserted toward the ischial tuberoscity where the pudendal nerve emerges from the pudendal canal and is guided by digits in the vagina until its tip is posterior and inferior to the ischial spine
What else does the anaesthetic block? The ilioinguinal nerve and its labial branches, which supply the vulva
The anaesthetic for the pudendal nerve does not block which sensations? Those from the anterior part of the perineum It does not abolish pain from uterine contractions
Which structures are cut in a medial episiotomy? Skin Wall of the vagina Bulb of vestibule covered with bulbospongiosus muscle Deep transversus perinei Superficial transversus perinei
What is meiosis? A specialized process of cell division that only occurs in the production of gametes It consists of 2 divisions that result in the formation of four gametes, each containing half the chromosomes and DNA in normal cells
What is the purpose of meiotic division? To enable the members of the homologous chromosome pair to exchange blocks of genetic material To provide each germ cell with both a haploid number of chromosomes and half the amount of DNA
When does spermatogenesis in the male begin? Primordial germ cells arrive in the testes at week 4, but remain dormant until puberty. At puberty, the germ cells differentiate into spermatogonia which undergo mitosis and provide a continuous supply of stem cells
Give a summary of the process of spermatogenesis Spermatogonia begin to give rise to primary spermatocytes which enter meoisis 1 Primary spermatocytes complete meosis 1 to form secondary spermatocytes Two secondary spermatocytes complete meiosis 2 to form 4 spermatids
What are spermatogonia? Stem cells situated along the BMof the seminferous tubules
What are the three types of spermatogonia according to nuclear appearance? 1) Type A dark 2) Type A pal 3) Type B
Describe the appearance of type A dark spermatogonia Large oval or rounded Condensed Chromatin Nucleoli Prominent vacuole
Describe the appearance of Type B spermatogonia Spherical nucleus with clumps of chromatin along the nuclear membrane Pale-stained Central nucleoli No nuclear vacuoli
What are the successive stages of spermatogonia development? Type A dark divide and form Type A pale Type A pale divide and differentiate into type B Type B differentiate into primary spermatocytes
Where do primary spermatocytes become secondary spermatocytes? In the middle zone of the seminferous epithelium
What are the characteristics of Primary spermatocytes? They are the largest spermatogenic cells Large nucleus with coarse clumps or thin threads of chromatin Contains 23 pairs of chromosomes and 4n DNA
The spermatids are embedded in: The cytoplasm of the side of the Sertoli cells
What are the characteristics of Secondary spermatocytes? Smaller than primary spermatocytes Rapidly undergo second meiotic division Rarely seen Contains 23 chromosomes and 2n DNA
What are the characteristics of spermatids? Small cells with 23 chromosomes and 1n DNA Haploid cells
What is spermiogenesis? A series of maturational changes in spermatids that results in the formation of spermatozoa
What processes are included in spermiogenesis? These include formation of the acrosome, condensation of the nucleus, formation of the head, neck, and tail
The total time of sperm formation is: 64 days
What is the first stage of spermiogenesis? The golgi apparatus elaborates a large vesicle, the acrosomal vesicles. which accumulates carbohydrates and hydrolytic enzymes
What is the second stage of spermiogenesis? The acrosomal vesicles become applied to one pole of the nucleus to form the acrosomal head cap
What is the third stage of spermiogenesis? Both centrioles of the spermatid migrate to the end of the cell opposite to the acrosomal head cap The centriole aligned parallel to the long axis of the nucleus elongates to form a flagellum
What is the fourth stage of spermiogenesis? 9 coarse fibrils which many contain contractile proteins become arranged longitudinally around the flagellum Further rib-like fibrils then become disposed circumferentially around the whole flagellum
What is the 5th stage of spermiogenesis? The cytoplasm migrates to surround the first part of the flagellum with the remainder of the flagellum appears to project from the cell The migration of cytoplasm concentrates mitochondria in the flagellar region
What is the final step of spermiogenesis? Excess cytoplasm is cast off the elongating flagellum and phagocytised by the enveloping Sertoli cell The mitochondria become arranged in a condensed, helical manner around the fibrils of the first part of the flagellum
What are the differences between 1) Spermatogenesis and 2) spermiogenesis? 1) Spermatozoa --> spermatid from diploid primordial germ cells Involves multiplication, growth, maturation, and differentiation Produces 4 spermatids 2) Haploid spermatids -->spermatozoa Only differentiation One spermatid --> 1 spermatozoon
What is the capacitation of sperm? A reversible process in which freshly ejaculated sperm develop the capacity to fertilize a secondary oocyte in the female reproductive tract
Capacitation of sperm involves what steps? 1) Unmasking of glycosyltransferases of the sperm cell membrane 2) Removal of surface coating proteins derived from seminal fluid
The wall of seminferous tubules has a BM lined with 2 types of cells: 1) Germinal cells / differnetiating spermatogenic cells 2) Supporting cells/ the Sertoli cells
Describe spermatozoa which lie in the seminiferous: They consists of a head, which contains a nucleus and a tail which will give motility to the free cells The chromatin is condensed giving the functionally mature cell greater mobility Acrosomal cap covers anterior 2/3rds of the nucleus
How long is the sperm tail and what are its parts? 55 microns The neck, middle piece, principal piece, and end piece
What is important about the neck of the sperm tail? It is is the region where the head and tail unite. It contains the connecting piece that joins the nine outer dense fibers of the tail to the implantation fossa of the nucleus
The region of the connecting piece that joins the implantation fossa in the sperm is called: The capitulum
What are the characteristics of the principal piece of the sperm tail? It is the longest part of the tail and consists of the axoneme and the nine coarse fibers a (2 + 9 + 9 arrangement)
What are the characteristics of the end piece of the sperm tail? It is the shortest segment of the tail and consists only of the axoneme surrounded by the plasmalemma
What are the characteristics of the middle piece of the sperm tail? Consists of the axoneme, the nine coarse fibers, and the helical sheath of mitochondria
What are the hormones needed for spermatogenesis? LH and FSH
LH is mediated by: Testosterone
Which two hormones act idrectly on the seminiferous tubules? Testosterone and FSH
What are Sertoli cells? Columnar cells which extend from the BM to the lumen of the seminferous tubules
Describe the histology of the Sertoli cells The nucleus is either ovoid or indented Prominent Nucleolus Contains smooth and rough endoplasmic reticulum Lysosomes Lipid droplets Microfilaments and microtubules
What is the function of the Sertoli cells? They provide nutrient to differentiating sperms Form tight junctions with each other --> blood-testis barrier which allows testosterone to pass but no substances which might damage developing sperms Secrete fluid into the lumen to help sperm transport
How do Sertoli cells synthesize estradiol? They are stimulated by FSH to do so They use testosterone produced by Leydig cells
Which substances from the Sertoli cells block testosterone synthesis via negative feedback? Activin and estradiol
What are the Interstitial cells of Leydig? Large, polyhedral cells with extensive eosinophilic cytoplasm which are present in groups embedded in loose CT between the tubules They are surrounded by blood capillary plexuses
What are the histologic features of the Leydig cells? Eccentric nucleus Ultrastructure resembles steroid secreting cells of the adrenal cortex
Which hormone stimulates Leydig cell activation? LH
Testosterone from the Leydig cells stimulate: Inhibin secretion from Sertoli cells Differentiation of peritubular cells
What is the major androgen and where is it synthesized? Testosterone Leydig cells
Unlike the androgen producing cells in the adrenal cortex, Leydig cells do not: Contain 21 or 11 beta -hydroxylase Synthesize glucocorticoids or mineral corticoids
How does LH stimulate testosterone? By stimulating cholesterol desmolase
Which enzyme in accessory sex organs convert testosterone to dihydrotestosterone? 5 alpha-reductase
Why are 5 a-reductase inhibitors like finasteride used in the treatment of benign prostatic hypertrophy? Because they block the conversion of testosterone to dihydrotestosterone in the prostate
When FSH stimulates Sertoli cells, what is produced? Stem cell factor Androgen Binding Protein Inhibin B and estradiol Activin
What is the function of stem cell factor? Interacts with specific receptors on the spermatogonium Stimulates mitosis and inhibits apoptosis of spermatogonia
Which enzyme is necessary for estradiol synthesis? Aromatase
What is the function of Androgen binding protein? Complexed with high affinity to testosterone, DHT, and estradiol Concentrates the sex steroids in the Sertoli cells so they can be used during spermatogenesis
What is the function of Activin? Stimulates spermatogonia to form primary spermatocytes
Created by: Ulaisl