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317 Cards in this Set
- Front
- Back
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Quadratus Lumborum Function
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Bilaterally extend vertebral column, stabilizes ribs, unilaterally flexes vertebral column
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Psoas Major Function
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Thigh Flexor, If legs are fixed, it flexes the trunk
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Psoas Major Innervation
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L1-L3 anterior rami
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Iliacus Function
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Hip flexion
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Iliacus Innervation
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L2-L4
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What attaches the diaphragm to the vertebral column?
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The crura and arcuate ligaments`
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Median arcuate ligament is made of...
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merging of 2 crura (right and left)
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Medial arcuate ligament is made of ....
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psoas major fascia
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lateral arcuate ligament is made of ....
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quadratum lumborum fascia
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All motor innervation of diaphragm is from what nerve?
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phrenic (C3-C5)
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The peripheral diaphragm is innervated by what nerves (sensory)
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segmental nerves of the body wall
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What is a Hiatal Hernia?
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Stomach herniates into esophagus
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What is a paraesophageal hernia?
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stomach herniates near esophagus
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Why are hiatal hernias more common with age?
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the esophageal hiatus weakens with age
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Blood supply to the thoracic surface of the diaphragm
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mostly pericardiophrenic artery
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Blood supply to abdominal side of diaphragm
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inferior phrenic arteries (1st branches of the aorta after the aortic hiatus)
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What nerve pierces Psoas Major
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Genitofemoral
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Why is the right kidney lower than the left?
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Liver is on the right
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What 3 nerves pass posteriorly to the kidneys
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Subcostal, Iliohypogastric, ilioinguinal
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What part of the GI tract sits in front of the Right Kidney?
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Descending duodenum
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What part of the GI tract sits in front of the left kidney?
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Tail of pancreas
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In a supine patient, from what vertebral levels do the renal arteries come from?
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Between L1/L2
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What is the anatomical relationship between the ureter and the iliac artery? In Males
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Ureter passes over the bifurcation of the common iliac artery
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What is the anatomical relationship between the ureter and the uterine artery? In Females.
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Ureter passes under it
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What is the anatomical relationship between the ureter and the ductus deferens? In males.
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Ureter passes under it
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Why can the uterine artery be mistaken for the ureter?
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Both look similar and even though the artery pulses, the ureter peristalses when touched.
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What happens if the ureter is ligated accidentally during surgery?
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urine backs up into kidney and damages kidney; hydronecrosis
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The aorticorenal ganglion recieves sympathetic preganglionic axons from ....
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least splanchnic
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Where is pain referred to for kidney stones?
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Between T11-L2, passes from "loin to groin"
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What are the 3 main blood vessels to the adrenal glands?
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Superior, Middle, Inferior adrenal glands
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What cells in the adrenal glands release epinephrine?
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Chromaffin cells
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What part of the sympathetic nervous system innervates the adrenal glands?
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Greater splanchnic nerves
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What is the parasympathetic innervation of the adrenal glands?
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There is no parasympathetic innervation of the adrenal glands
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Abdominal Aortic Aneurysm
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pressure builds in the abdominal aorta below the renal arteries, hopefully. inferior mesenteric artery may be compromised if we have to stent it
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If the thoracic duct is damaged, where will we see edema?
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In areas more distal to it
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What arte the 2 major contributors to the portal vein?
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SMV and splenic vein (inferior mesenteric vein usually joins with splenic or SMV first)
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What vertebral leve does the portal vein form?
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L1/Transpyloric, anterior to IVC,
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How does venous blood look different from arterial blood when a person is bleeding?
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Venous blood is darker
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How do hemorrhoids form?
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Portal-caval anastomoses that goes to the veins of the anal canals
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Below the dentate line, external rectal plexus drains in to what?
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IVC
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Below the dentate line, the internal rectal veins drain to where?
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Portal vein
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Liver functions
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Make bile, make blood proteins, detox blood, metabolize nutrients
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Largest gland of the body
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Liver (skin isn't technically a gland)
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Liver is derived from what gut structure?
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Duodenum
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The liver stroma is made up of what ...
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connective tissue capsule (Type 1 collagen) and reticular framework (type 3 collagen)
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Liver parenchyma is made up of what cells mostly?
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Hepatocytes, derived from foregut endoderm
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What are the 2 blood supplies to the liver? And what % of blood supply do they account for?
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Portal Vein (75%) and Hepatic artery (25%)
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Where do portal blood and oxygenated hepatic artery blood mix in the liver?
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Sinusoids
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Portal triads, within the liver, contain ...
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portal venules, hepatic artery branches, bile duct branches
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What are Canals of Hering
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bile ductules that receive bile from the canaliculi
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Why do liver cells have lipofuschin?
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They are very long lived
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Venous blood from the portal triads flows towards what central structure?
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Central vein
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According to the classic lobule model of the liver, where are the portal triads located
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Around the lobule, central vein in the middle
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The classic lobule model of the liver is based on what property?
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Blood flow direction. Blood from peripheral portal veins pours into central vein
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According to the portal lobule model of the liver, where are the portal triads located
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in the center of the lobe
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The portal lobule model of the liver is based on what property?
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Bile flow direction. Bile flows towards bile duct in the portal triad
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Which model of liver lobules is mostly used for functional understanding of the liver?
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Liver acinus model
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According to the liver acinus model of liver lobules, what cell zone is most at risk for ischemia?
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Zone 3
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According to the liver acinus model of liver lobules, what cell zone is most at risk if direct toxins are ingested?
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Zone1
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What is centrilobular necrosis?
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death of Zone 3 liver cells, but according to the classic model, these are the central cells, hence the name centrilobular
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3 phases of Alcoholic liver disease
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Fatty Liver (reversible), Alcohol hepatitis, cirrhosis
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Which zone of liver cells are most affected by fatty liver disease in alcoholics?
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zone 3, the centrilobular cells
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what is Alcoholic Hepatitis
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neutrophilic inflammation in liver; necrosis of hepatocytes in the central zone (Zone 3, around the central vein
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What is Liver Cirrhosis?
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scarring of the liver leading to liver failure and portal hypertension. edema is seen
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Causes of liver cirrhosis?
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Alcoholism, hepatitis C, toxic exposure, drug use
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What is cardiac cirrhosis?
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Heart failure causes liver damage and cirrhosis. zone 3 necrosis due to hypoxia
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Why are Kupffer cells seen in the liver?
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They are associated with sinusoid capillaries that are found in the liver
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What is the function of Ito cells?
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Store vitamin A
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4 distinct layers of GI tract
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Mucosa, submucosa, muscularis externa, serosa/Adventitia
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3 parts of mucosa layer of la stomacha... the stomach, dana
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epithelium/basal lamina, lamina propria, muscularis mucosae
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Describe the muscular arrangement in the muscularis mucosa layer of the GI tract.
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Inner layer of circular muscles. outer layer of longitudinal
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What is between the inner and outer muscle layers of the muscularis externa of the GI tract
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Auerbach's plexus (myenteric)
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In what GI tract layer contains the Meissner's Plexus?
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Submucosal
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The serosa layer of the GI tract is made of what epithelium?
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mesothelium
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Esophageal cardiac glands do what?
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secrete neutral PH mucus to protect esophagus from stomach acid
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Where are esophageal cardiac glands found?
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Lower esophagus lamina propria
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The muscularis mucosa of esophagus is only one layer in what direction?
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longitudinally
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How can we differentiate vagina and esophagus in H/E stains?
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Esophagus has smooth muscle in muscularis mucosa (but, only in the middle and lower portion of the esophagus)
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How can we differentiate the upper, middle, lower esophagus in H/E slides?
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Upper = skeletal muscle only. Middle = skeletal and smooth. Lower = smooth muscle only
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4 parts of the stomach
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Fundus, cardia, pylorus, body
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Epithelium of gastric mucosa
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Simple columnar with NO goblet cells
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Gastric cardia region function
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mucus secretion
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Describe the histology of stomach fundus and body
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short gastric pits, long glands
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Describe the histology of stomach pyloric region
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deep pits, short glands
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What color do parietal cells in the stomach stain in H/E?
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red, eosinophilic
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What color do chief cells in the stomach stain in H/E?
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blue, basophilic
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What part of the gastric glands have parietal cells?
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upper gastric gland
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What part of the gastric glands have chief cells?
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lower gastric gland
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Function of Parietal cells
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create H+ from H2CO3. Actively pump H+ into lumen. in the lumen it combines with Cl-
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Relationship between parietal cells and B12
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Parietal cells secrete intrinsic factor needed for B12 absorption
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What is pernicious anemia?
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lack of intrinsic factor so B12 is not absorbed; Low RBC, Low hemoglobin
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B12 effects on nervous system?
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degeneration of spinal cord
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B12 deficiency can be confused with what other diagnosis?
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Multiple sclerosis
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What is a key symptom of B12 deficiency
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burning of soles of the feet
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Why are chief cells basophillic?
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High RER making pepsinogen
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What does pepsinogen convert into? Where?
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pepsin, in the acidic gut lumen
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Enteroendocrine cells secrete their products where?
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lamina propria
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product of duodenal Enteroendocrine cells?
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CCK, Gastric Inhibitory Peptide, secretin
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3 layers of gastric muscles in the muscularis externa
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inner oblique, middle circular, outer longitudinal
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Crypts of Lieberkuhn
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intestinal glands within lamina propria. Contain paneth cells
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Paneth cells
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eosinophillic lysozyme granules to break down bacterial cell walls
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What are the 3 levels of folding in the small intestines?
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Pliae Circulae, villi, microvilli
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Pliae circulae
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submucosal permanent folds to increase surface area
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Describe the muscularis externa of the small intestine
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inner circular layer, outer longitudinal layer
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What 2 cells are found in the GI tract to support immune function?
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M cells and plasma cells (and lymphocytes)
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What are M cells in the GI Tract?
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cover peyer's patches. phagocytize organisms/molecules from lumen and present to CD4+ T cells in lamina propria
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Where do M cells present antigens in the GI Tract?
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lamina propria of small intestines
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How does IgA in the GI tract enter the lumen
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binds to secretory component of enterocytes
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fun fact: only duodenum submucosa has glands. no other part of GI has glands in submucosa
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sweeeeeeeet
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Brunner's glands function
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in submucosa of duodenum. secrete basic substance to neutralize acid chyme fresh from stomach. optimizes ph for pancreatic enzymes
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enteroendocrine cells of duodenum secrete what?
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CCK, GIP, secretin
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CCK Function
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stimulates gallbladder contraction, pancreatic enzyme and bicarbonate secretions. inhibits gastric emptying
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GIP (Gastric inhibitory protein) function
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shuts off acid production
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Secretin Function
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stimulate pancreatic secretion, inhibit gastric acid production
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What makes up the pyloric sphincter?
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Thickening of the inner circular layer of the muscularis externa
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What part of the small intestine has the most developed pliae circulares?
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Jejunem
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Peyer's Patches are found in what part of the small intestines?
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ileum
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What part of the small intestines has the most goblet cells?
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ileum
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Function of the colon
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Absorb water, compact and move feces
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Fun Fact: there are no villi in the colon
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asssssssss
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What do goblet cells in the colon do mainly?
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make mucus to lubricate stool movement in colon
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Are there paneth cells in the large intestine?
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NO
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Teniae coli
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3 longitudinal bands of the muscularis externa of the colon
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What makes up the internal anal sphincter?
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smooth muscle, thickening of the inner circular layer of muscularis externa
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Internal anal sphincter innervation
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parasympathetic = relaxation. contracts with sympathetics
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External anal sphincter innervation
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skeletal muscle. inferior anal branches of pudendal nerve (S2,3,4)
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What changes in epithelium occur at the anorectal junction?
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simple columnar to strat. squamous non-keratin to strat. squamous keratin
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Atrophic gastritis cause
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B12/intrinsic factor deficiency with parietal cells
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Describe the Connective tissue of the submucosal lining of the GI tract
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dense regular
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Below the diaphragm, what is the outer surface covering of the GI tract?
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serosa
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Above the diaphragm, what is the outer surface covering of the GI tract?
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adventitia
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What is the space of Disse?
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In the liver it is where blood in the sinusoids contacts hepatocyte microvilli
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Bile is made up of ...
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bile salts, phospholipids, cholesterol, bilirubin, water
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Fun Fact: 90% of bile is reabsorbed in intestines.
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10% is made by hepatocytes
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Where do Bile canaliculi take bile?
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towards bile ductules and ultimately the portal triad (bile ducts in triad)
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What forms the bile canaliculi?
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grooves on the edges of hepatocytes. the canals are just passing between the neighboring hepatocytes. sealed by tight juctions
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3 components of the Biliary tree, after bile canaliculi
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bile ductules, bile ducts, heaptic ducts
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Flow of bile from a hepatocyte to the duodenum
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bile canaliculi, bile ductule, bile ducts, hepatic duct, common hepatic duct, joins cystic duct to form bile duct, ampulla of Vater/Sphincter of Oddi
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Gallbladder function
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store and concentrate bile
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What stimulates the gallbladder to release bile?
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CCK
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Gallbladder epithelium
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simple columnar to absorb water from bile. functions to concentrate bile
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Fun Fact: Gallbladder has NO submucosa
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ooooooooookkkkkay
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Gallbladder is derived from what GI part
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duodenum
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what are Rokitansky-Aschoff sinuses?
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deep invaginations of mucosa in the gallbladder
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What 3 features of gallbladder cells are different from intestines?
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no goblet cells, mucus invaginations/no villi, no submucosa layer
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CCK is made where?
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by the enteroendocrine cells of the duodenum
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Describe the flow of enzymes in the exocrine pancreas
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secretin is detected. centroacinar cells, inercalated duct, intralobular ducts, pancreatic duct, ampulla of Vater
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What epithelium is found in the intercalated duct?
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simple Cuboidal
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What epithelium is found in the intralobular duct?
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simple columnar
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Spleen white pulp function
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filter and survey blood for antigens
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Spleen red pulp function
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filter, degrade, recycle RBCs
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What vessels are found in the hilum of the kidney?
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Nerves, arteries, veins, lymphatics, ureter
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What are columns of Bertin?
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space between medullary pyramids
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5 Main parts of a nephron
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renal corpuscle, proximal convoluted tube, loop of henle, distal convoluted tube, collecting tube
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Renal corpuscle function
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filter blood in glomerulus (surrounded by Bowman's Capsule)
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What specialized epithelial cells are found with the visceral layer of the renal corpuscle?
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podocytes
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What is found at the vascular pole of the renal corpuscle?
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afferent arteriole, glomerular capillaries, efferent arteriole
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What is found at the urinary pole of the renal corpuscle?
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proximal convoluted tubule begins
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Basal straitions indicate what?
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lots of mitochindria for ion exchange
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In the urinary pole of the renal corpuscle, there is a change of epithelium as the proximal tubule begins? What is the change?
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Simple squamous (parietal layer of Bowman's capsule) to columnar/cuboidal with brush border
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What are pedicels?
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the interdigitating parts of podocytes surrounding the glomerular capillaries. form filtration slits
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What are the 3 components of the filtration barrier in the glomerulus?
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endothelium of glomerular capillaries, basement membrane (most important), podocytes
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What type of capillaries are found in the glomerulus?
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fenestrated capillaries with no diaphragms
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What are the 3 layers of the glomerular basement membrane?
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lamina rarae, lamina densa, lamina rarae
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What is the function of the lamina densa in the glomerular basement membrane?
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collagen type 4 is a physical barrier to proteins > 69 kDa
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What is the function of the lamina rarae in the glomerular basement membrane?
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prevent charged particles from passing. uses anionic heparan sulfate
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What is anionic heparan sulfate used for in the glomerulus?
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in the lamina rarae of the basement membrane, it prevents charged particles from entering urine
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In the glomerulus, the internal lamina rarae lies superficial to what glomerular structure?
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endothelium of the glomerular capillaries
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In the glomerulus, the external lamina rarae lies deep to what glomerular structure?
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podocytes
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What are mesangial cells?
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support the capillaries of the glomerulus, phagocytize the trapped filtration barrier contents, may constrict with angiotensin II
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Explain the pathogenesis of "immune" glomerulonephritis.
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after illness, antibody-antigen complexes may be trapped in basement membrane of glomerulus. immune system attacks basement membrane and we see poor filtration of urine
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Explain the pathogenesis of hypertension causing "non-immune" glomerulonephritis.
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hypertensive patients have endothelial damage, mesangial cell proliferation in response to injury and basal lamina thickening. leads to poor filtration in glomerulus
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Explain the pathogenesis of diabetes mellitus causing "non-immune" glomerulonephritis.
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diabetes causes thickening of type 4 collagen. lamina densa thickens and filtration is poor
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Explain the pathogenesis of Good Pasture Syndrome causing "immune" glomerulonephritis.
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auto-antibodies form to type 4 collagen. basement membrane of glomerulus is attacked. poor filtration
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Why are proximal convoluted tubules more prevalent in H/E sections?
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They are longer than the distal tubules
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Why do diabetics have glucose in the urine?
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There is too much glucose for the proximal tubules to remove
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What is a simple explanation for high protein levels (albumin) in the urine?
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Damage to the lamina densa/collagen type 4/basement membrane
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what is Proteinuria?
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abnormal levels of protein in the urine
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What is absorbed from the filtrate in the proximal tubules?
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water, Na, glucose, amino acids, small protein
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Basic function of ADH
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Allows water to be drawn out of collecting duct to form concentrated urine
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Why do patients with diabetes insipidus have hypotonic urine?
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They do not have ADH
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In normal people, how is ADH secretion stopped?
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By high water intake, high blood volume
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What is the function of aldosterone in the distal tubules
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allows for sodium and potassium to be reabsorbed into the filtrate
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What affect does the distal convoluted tubule have on pH of urine?
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Final adjustments of ph of urine. secretes H+ and ammonium
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3 parts of the juxtaglomerular apparatus
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macula densa, Juxtaglomerular cells, extraglomerular mesangial cells
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Function of the jugtaglomerular apparatus?
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regulate BP via renin-angiotensin pathway
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JG cells secrete what protein
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renin
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What are the functions of the macula densa
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Monitor NaCl levels in filtrate, regulate GFR, regulate renin levels
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What is renins direct function?
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convert angiotensinogen into angiotensin I
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What converts angiotensin I to angiotensin II?
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ACE, Angiotensin converting enzyme
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Where is angiotensin I converted to angiotensin II?
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endothelium of lung capillaries
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Angiotensin II stimulates release of what hormone, from where?
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aldosterone, from zona glomerulosa of adrenal cortex
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Function of aldosterone
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increases reabsorption of sodium (and then water indirectly) into the blood in distal tubules. raises BP
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Angiotensin II function
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potent vasocontriction = raises BP
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Why are ACE inhibitors used for hypertensive patients?
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The prevent angiotensin II from being formed. less vasoconstriction
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Collecting ducts empty into what part of the kidney?
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minor calyx
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What type of epithelium lines the minor calyx of the kidneys?
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Transitional
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Describe the muscular layers in the urinary passages
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inner longitudinal layer, outer circular (opposite of GI tract)
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How does basement membrane damage cause edema?
|
albumin can leak out of basement membrane into urine. low albumin = low venous colloid pressure = water remains in tissue fluid = edema
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Where is ADH produced?
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paraventricular nucleus of hypothalamus, released into posterior pituitary
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Describe the pelvic peritoneum
|
it is draped over the pelvic organs, descends into pouches (Pouch of douglas)
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Fun Fact: Internal iliac runs under the pelvic peritoneum
|
turn my swag onnnnnnnnnn
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Where is the prostate relative to the bladder?
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underneath it
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What happens to the sacroiliac joints with age?
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become ossified, pain when walking
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What is the most commonly slipped disc?
|
L5/S1
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Angle of pubic arch in females
|
80 degrees
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angle of pubic arch in males
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50 degrees
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What is the narrowest fixed distance a baby's head must pass during child birth?
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obstetric conjugate (not affected by relaxin)
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What is narrowest part of pelvic canal?
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interspinous distance (but relaxin can make it wider during childbirth)
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How does an OBGYN determine if the fetal head is ready to come through during birth?
|
if 3 fingers can fit side by side in vagina, the iscial tuberosities are far apart enough to give birth
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The "obstetric conjugate" should be how big for successful childbirth
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11.5 cm at least
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The "diagonal conjugate" should be how big for successful childbirth
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13 cm at least
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The "diagonal conjugate" is the distance between what?
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pubic symphysis and sacral promontory
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The pudendal canal is made from what muscle's fascia
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obturator internus
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What is the anatomical relationship of the coccygeus to the piriformis
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it is inferior to the piiformis
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Coccygeus and levator ani function
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support pelvic floor/viscera, pull coccyx forward after defectation
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Relaxation of the puborectalis muscle allows for what?
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defecation to occur
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What passes through the urogenital hiatus?
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Urethra and vagina
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What is the anatomical relationship of the urethra to the vagina?
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urethra is embedded in the anterior wall of vagina
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Sigmoid colon becomes rectum at what vertebral level
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S3
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What is the perineal flexure
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the 80 degree angle of the anorectal junction held by the puborectalis muscle. controls feces
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GI/Visceral endoderm becomes ectoderm at what landmark?
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pectinate line/proctodeal membrane
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Above the pectinate line, sensory afferents are ...
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visceral
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Below the pectinate line, sensory afferents are ...
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somatic
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What is the anal pectin
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middle anal canal region, below pectinate line and above white line of hilton. strat. squamous non-keratinized
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Where is the transition from stratified squamous non-keratinized to skin in the anal canal?
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White line of hilton
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Below the pectinate line, veins drain to the ....
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caval system, IVC
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Below the pectinate line, lymph drains to the ....
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superficial inguinal nodes
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Above the pectinate line, lymph drains to the ....
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internal iliac nodes
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Above the pectinate line, veins drain to the ....
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portal system
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above the pectinate line, arterial supply is ....
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IMA
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Below the pectinate line, arterial supply is ....
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internal iliac artery
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Superior rectal artery comes from....
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IMA
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Superior rectal vein drains to what system?
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portal
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Middle and inferior rectal vein drains to what system?
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caval
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The internal rectal plexus of veins is above or below the pectinate line?
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above
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The external rectal plexus of veins is above or below the pectinate line?
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below
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Internal hemorrhoids are also called..
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piles
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Fun Fact: Internal hemorrhoids can prolapse into anal canal
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think about that during dinner
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What can happen if a fistula forms between rectum and bladder/vagina
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shit enters the vag and you piss feces
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As the bladder fills, what direction does it move in the body?
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superiorly
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Pouch of Douglas sits between what 2 structures in males?
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rectum and bladder
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Pouch of Douglas sits between what 2 structures in females?
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rectum and uterus
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What is the trigone?
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triangular region of the bladder, surrounded by detrussor muscles
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What is micturation?
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pissssssssssssssssing
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Explain the detrussor reflex
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sensory stretch fibers run with parasympathetics, efferents cause detrussor muscle contraction and bladder release. regulated by pontine micturation center in pons
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What controls the external urinary sphincter?
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onuf's nucleus S3,S4 spinal cord, skeletal muscle
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If spinal injury damages descending pathways, what can happen to detrussor reflex?
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no longer functional. bladder empties when its full. seen in babies
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Where is pelvic brim?
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bifurcation of common iliacs
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4 parts of the male urethra
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preprostatic, prostatic, membranous, spongy
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BPH mostly affects which part of the make urethra
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prostatic urethra
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Left testicular vein drains into what?
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left renal vein
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Right testicular vein drains into what?
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IVC
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Epididymis function
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store sperm and acquire motility
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The ductus deferens spans from ....
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tail of epididymis to the ejaculatory duct
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The ejaculatory duct is a combination of which 2 vessels?
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seminal vesicle and ductus deferens
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Where are the cavernous nerves found?
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fibrous capsule of the prostate. control erections
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Fun Fact: Superficial lobes of the prostate are more prone to cancer than the deeper lobes.
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who gives a fuck
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Benign Prostate Hypertrophy symptoms
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hypertrophy blocks urethra. nocturia (pee at night) dysuria (painful peeing)
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"Gold standard" treatment for prostate carcinoma
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radical prostectomy
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Why do patients with prostate cancer have lumbar back pain
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prostate cancer cells can travel to batsons plexus and metastasize
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What is analogous to the spermatic cord in females?
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round ligament of uterus
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What is the function of fimbriae?
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Oocytes are released by the ovary into the peritoneal space. fimbriae fingers pull it back into the fallopian tube
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What is Bartholinitis
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inflammation of the Bartholin glands in females
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Where are the ovary's nerves and blood supply found?
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in the suspensory ligament of the uterus
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The uterine/fallopian tube is held by what part of the broad ligament?
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mesosalpinx
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The ovary is held up by what part of the broad ligament?
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mesovarium
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The uterine artery is held in place by what? females
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cardinal ligament
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The female remnant of the gubernaculum is the ...
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ligament of ovary (and round ligament also)
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Fertilization occurs in what part of the tract?
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Ampulla/Fallopian tubes
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Round ligament connects the ...
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uterus to labia majora
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Ligament of ovary connects ....
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uterus to ovary
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What is mesometrium?
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Mesentary for the uterus
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Fun Fact: there are anastomoses between uterine and ovarian arteries
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cool story bro, tell it again
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What is hysterosalpingogram?
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test to see the shape of the uterus. inject water soluble dye to see if mucus is blocking uterine tubes
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Why are vaginal and uterine infections very dangerous?
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They can spread into the peritoneal cavity easily, causing peritoniitis.
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How can we sample fluid in the Pouch of motherfucking Douglas.
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Culdoscopy. Enter through vagina and penetrate needle into posterior fornix of vagina
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Ovary lymph drains to ...
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lumbar nodes
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Mid vagina to utereus lymph drains to ....
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internal iliac nodes
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lymph in the ostium of vagina below hymen drains to ....
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superficial inguinal nodes
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In females what is the major support of the uterine organs? (ligaments or pelvic diaphragms/muscles)
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pelvic diaphragm, levator ani muscles, perineum muscles are the strength of the support
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How can childbirth lead to stress incontinence?
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Childbirth weakens the pelvic diaphragm = organs can prolapse/move. if bladder prolapses, it is no longer being sealed by the intra-abdominal pressure. during stress, bladder leaks
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What nerve passes immediately medial to psoas major
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obturator nerve
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In the pelvis, sympathetics travel to the _______ splanchnics
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sacral
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In the pelvis, parasympathetics travel to the _______ splanchnics
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pelvis
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The anterior division of the internal iliac mostly supplies ....
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pelvic viscera
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The posterior division of the internal iliac mostly supplies ....
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body wall
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What is the anterior triangle of the perineum?
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urogenital triangle
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What is the posterior triangle of the perineum?
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anal triangle
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What is important to note about the planes of the anal and urogenital triangle?
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They are not in the same plane. urogenital is horizontal, anal is sloped upwards
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Superficial perineal space is between what two layers?
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perineal membrane and Collie's Fascia
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Urine collecting in the superficial perineal space cannot enter the anal triangle. Why?
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Colles fascia is tight with perineal body
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Deep fascia of the penis is also called...
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Bucks fascia
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what is Gallaudetts fascia
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the deep perineal fascia surrounding the muscles
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Superficial perineal space contents
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erectile tissues (corpora cavernosa, spongiosum, penis bulb, Bartholin glands), erectile muscles and Gallaudetts fascia, internal pudendal nerve and artery
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What are the 3 erectile masses of the penis?
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1 corpora spongiosum, 2 corpora cavernosa
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What is the Tunica Albuginea?
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dense fibrous capsule layer over the corpora cavernosa in the penis
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Why doesn't the corpus spongiosum get rigid during erection
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it contains the urethra. if it became rigid, the urethra would be compressed
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innervation of bulbospongiosus and ischiocavernous muscles of penis
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perineal nerve (branch of pudendal) s3, s4
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Sensory afferents from the penis use what nerve?
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dorsal nerve of penis (S2, S3, S4) (Terminal branch of pudendal)
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If pudendal nerve is damaged why can erection still occur
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physical erection is controlled by descending pathways from cortex
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Parasympathetic nerves to the penis travel in what
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pelvic slpanchnics
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Parasympathetics to the penis use what neurotransmitters
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ACH, NO
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Why is it dangerous to have an erection for too long?
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during erection, ischiocavernous and bulbospongiosum muscles block veins from draining blood in penis. no oxygenated blood is entering the penis. ischemia can occur
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How do ACH and NO induce an erection?
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relax the helicine arteries and blood flows into the penis
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Explain the process of ejaculation and the innervations for each step
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1) close internal urethral bladder sphincter (symp. L1-L2) 2) contraction of urethral smooth muscle (parasymp. S2-S4) 3) contraction of bulbospongiosum is somatic (S2-S4, pudendal)
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What muscle contracts to assist the cremasteric muscle in bringing the testes close to the body?
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Dartos muscle
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In females, what is homologous to the scrotum?
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labia majora
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What is episiotomy?
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During childbirth, OBGYN can cut the vaginal orifice wider open. Must be careful of central tendon of pernieum
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Muscles of the deep perineal space in males?
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deep transverse perineal muscles, external urethral sphincter
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Muscles of the deep perineal space in females?
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deep transverse perineal muscles, external urethral sphincter AND sphincter urethrovaginalis, compressor urethrae
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What can form in the ischioanal fossa?
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abcess in the sides of anal canal (fossa)
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The pudendal canal is a specialization of what muscle's fascia?
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obturator internus
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Describe the flow of blood from the internal iliac to the perineum.
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internal iliac - anterior division - internal pudendal artery (out greater sciatic foramen, in lesser sciatic foramen, around ischial spine)- pudendal canal- perineum/triangles
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Major somatic innervation of the perineum
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Pudendal nerve (S2-S4)
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What is bicycle seat neuropathy?
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compression of pudendal nerve in Alcock's canal. numbness and impotence.
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During a pudendal nerve block, what bony landmark is used to find the pudendal nerve?
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Ischial spine
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