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332 Cards in this Set

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proprioceptors impacting balance
golgi tendon
muscle spindles
pacinian corpuscles (deep pressure mechanoreceptors)
provides passive bony stability to arches in foot
talus - keystone* keeps boney structures in place
planter fascia provides
passive support for longitudinal arches
plater calcaneonavicular (spring ligament)
runs from calcaneous to navicular bone, passive support to longitudinal arch
why do the elderly generally have more
balance issues
proprioceptors are not as robust
golgi tendon
muscle spindles
pacinian corpuscles
dorsiflexion
aka extension
lifting foot up away from group
planter flexion
pointing foot toward the ground
midline of the foot for refrence of abduction/adduction
2nd digit
testing planter reflex
run something up lateral edge of foot from heel to toe
after two-- toes should flex
abnormal-- extension of toes with some abduction, Babinski sign
babinskin indicates
possible problem with upper motor neurons
gout
arthritic condition in joints (become extremely sensitive)
commonly in 1st digit of foot but can occur anywhere
caused by diet - excess uric acid (in purine proteins)
uric crystals form within joint, can have bone erosion
bones participating in articulation of ankle joint
lateral malleolus (fibula)
medial malleolus (tibula)
trochlea of talus
primary movements of ankle joint
dorsiflexion and plantarflexion
hammer toe
joint between 1st and 2nd phalanx is hyperextended
tarsal tunnel syndrome
Tibial nerve (will split into medial and later planter) can be entrapped and compressed, can cause inflammation and infection
ganglion cysts
form around inferior extensor retinaculum, compress neurovascular bundle
plantar fasciatis
microtears in fascia,causing inflammation
common in runners
pain radiates from heel up and worse after sitting/lying down
muscles involved in forming Achillis tendon
soleus
plantaris
gastronemius
plater-flexion and active support of arches
Damage to Achillis tendon
impact gait
cause inability to plantar-flex
compartment syndrome
bleeding/swelling in any one compartment
causes compression
infection will travel path of least resistance
why are foot infections common in diabetes
decreased blood flow to foot, loose cutaneous sensation
create the compartments in the foot
plantar aponeurosis, the compartments are:
medial
central
lateral
interosseous
muscles found in layer 1 of foot
abductor hallucis
abductor digit minimi (underlying lateral plantar fascia)
flexor digitorum brevis
muscles found in layer 2 of foot
quadratus plantae
lumbricals
both attach to tendons of flexor digitorum longus
muscles found in layer 3 of foot
adductor hallucis
flexor hallucis brevis
flexor digit minimi brevis
muscles found in layer 4 of foot
dorsal interosseous (4 ABDuctors)
plantar interosseous (3 ADDuctors)
medial plantar nerve innervates...
only 4 muscle in foot
flexor digitorum brevis
flexor hallucis brevis
ABDuctor hallucis
1st (median) lumbrical
everything else in the foot is innervated via lateral plantar
arterial supply to first digit of foot
arcuate deep plantar
where can pulse be found along dorsum of foot
dorsalis pedis artery - continuation of ant. tibial
pulse felt lateral to tendon of extensor hallucis longus as it emerges from extensor retinaculum
where can pulse be found along medial aspect of foot
posterior tibial pulse - can be felt between medial malleolus and calcaneal tendon
as it runs down anterior leg and into dorsum of the foot, the anterior tibial artery is accompanied by
deep fibular nerve
at ankle, there is a rich anastomosis from what arteries
malleolar
tarsal
arcuate
below the knee, posterior tibial artery gives rise to fibular artery, which courses deep to
flexor hallucis longus
as it runs down posterior leg and into sole of the foot, the posterior tibial artery is accompanied by
tibial nerve
as posterior tibial artery enters sole of the foot...
divides into medial and lateral plantar arteries
lateral plantar is much bigger -- forms majority of plantar arch
plantar arch is formed by
lateral plantar (majority)
plantar branches
dorsalis pedis artery
plantar arch gives rise to
plantar metarsal arteries which give rise to proper plantar digital branches
in the foot, want to keep vasculature away from
heel and ball
corona phlebectatica
dialated veins in foot
indication of venous insufficiency
common in elderly who have weakened venous valves
mortons neuroma (intermetatarsal neuroma)
entrapment and compression of common digital nerve (branch of medial plantar),
commonly between digits 3 and 4
can happen from wearing too-tight shoes, get burning/tingling
as you irritate a nerve via compression...
nerve becomes enlarged and can eventually lead to permanent nerve damage
arcuate artery
arch on dorsal surface of foot
anastomoses with lat/ tarsal artery to form arch
give rise to 1st metarsal, metarsals, proper digitals, deep plantar artery
hallux valus
bunion
first digit starts going lateral, can even overlap with 2nd digit, flexor hallicus longus becomes misaligned, sesamoid bone goes out of plaec,
bursa (bunion) forms
impacts walking
subtalar joint
between talus and calcaneous
where eversion and inversion occurs
club foot
genetic - more common in males
involves subtalar joint
shorted medial muscles and ligaments , pulling foot into inverted position
cant stand on plantar surface of foot
Pott's fracture
due to extreme inversion
one or more malleoli fractured
torn ligaments
fractured fibula
medial malleolus avulsion
ankle sprain
tearing ligaments, most caused by rolling foot inward
possible fractures of foot eversion
single - fibula or medial malleolus
bimalleolar - lateral and medial
trimalleolar - lateral, medial, posteror
all can occur with or without dislocation of trochlea
provides stability to medial side of ankle
deltoid ligament
provides stability to lateral side of ankle
lateral ligament of ankle, not as stable
3 parts with the anterior talofibular ligament being the weakest
provide stability to plantar portion of foot arch
plantar aponeurosis
plantar ligament (long)
plantar ligament (short) calcaneocubidal
provide stability to medial portion of foot arch
spring ligament (calcaneonavicular)
2 tendons - fibularis longus tendon and tibilias posterior tendon
transverse arch
runs along midsection of foot (transversally)
essentially the midfoot:
cuboidal
navicular
3 cuneiforms
longitudinal arch
runs anterior to posterior, has lateral and medial parts
lateral portion of longitudinal arch consists of
calcaneous
cuboid
lateral 2 metatarsals
medial portion of longitudinal arch
calcaneous
talus
navicular
all 3 cuneiforms
metatarsals 1 2 3
the medial side of the foot...
not touching ground
allows weight to move anterior and posterior
consists of 2 arches
lateral side of foot
touching ground
gait cycle
stance phase: weight posterior to back of foot --> anterior to 1st and 2nd digits
so weight goes from tibia - ankle joint - calcaneous - metatarsals
arches of the foot allow
weight to shift
episiotomy
incision of perineum and inferior-posterior vagina wall
may be used during labor/delivery to enlarge vaginal oriface to decrease tearing of perineum and uncontrolled jagged tears of perineal muscles
median vs. mediolateral
4 parts of male urethra
preprostatic -- very short
prostatic
membranous
penile or spongy
seminal colliculus
dome-shaped region in/along prostatic urethra
on either side is where the prostate glands are draining into the prostatic urethra
prostates role in ejaculatory process
glands secrete (stimulated via sympathetics) into semen
help provide nutrition and proper environment for sperm in ejaculate.
prostatic utricle
invagination sitting on seminal colliculus
remnant of what would have developed into uterus/vagina
often place or just adjacent to where ejaculatory duct enters prostatic urethra
bulbourethral glands
in males deep peritoneal pouch
tiny gland that secrete mucus - cleanses and removes urine in urethra, allowing for safer/cleaner passage of semen through urethra
penile urethra
spongy, goes through corpus spongiosum erectile tissue
equinus gait
walking only on forefoot
can be caused by:
spastic or contracture of tibialis anterior
cerebral palsy
club foot
antalgic gait
how it looks when things hurt when you walk
keeping steps and movements small to minimize movement
tension based -- increased intraarticular pressure
ataxia
loss of ability to coordinate muscular movement
unconscious preception of movement and spatial orientation arising from stimuli within body itself
proprioception
impaired proprioception can cause
sensory ataxia
hypotonia
muscle weakness
Trendelenburg Gait
excessive trunk lateral flexion
(ipsilateral) weakness of lateral gluteal muscles
hypertonia
too much muscle contraction -- spasticity
scissors gait
spasticity associated with adductors
usually caused by cerebral palsy
foot slap gait
caused by weak dorsiflexor
foot "slaps" at substrate
physiological problems associated with genu recurvatum
quadriceps weakness
achilles tendon contracture
plantar-flexor spasticity
-- knee is hyperextended
pes cavus
high arch
pes planus
flat foot
valgus forefoot
plantar aspect of forefoot is everted
varus forefoot
plantar aspect of forefoot is inverted
excessive femoral medial rotation
caused by:
tight medial hamstring
anteverted femoral shaft
weakness of opposing muscle group
male urethra starts at
internal urethra orifice
males - in active urination
parasympathetics causes bladder to constrict and internal urethral sphincter to relax
in women, urinary incontinence is maintained by
external urethral sphincter
where spermatogenesis is occuring, sperm are being produced
testis
efferent ducts
about dozen very small tubes, funnel sperm into epididymis
epididymis
single highly coiled tube (15 cm long)
stretched out it would be about 4m
sits on posterior part of testis
role of epididymis
modifies surface proteins of sperm
prepares them to become motile
resorbs some testicular fluid
sperm stored in inferior pole until emission, released into tail of vas deferens
vas deferens
runs up back of scrotom (easy access for vastectomy)
thick musclular wall
runs through spermatic cord, superficial inguinal rung, deep inguinal ring, down toward prostate
prostate
where seminal vesicle and vas deferens come together to form ejaculatory duct,
has several individual glands that drain independtly into prostatic urethra
seminal vesicle
sits superior lateral to prostate,
highly coiled tubular gland with one duct
provides sperm with fructose as energy source so tail can be motile
2nd leading cause of death in males behind lung cancer
prostate cancer
250,00 deaths/year
where fluid may accumulate in male pelvic region
rectovesical pouch
% of men that will experience some type of prostate cancer
75%, risk increases with age
transition zone of prostate
site of benign prostatic hyperplasia
*the one most men tend to get
proliferation of cells can put pressure on prostatic urethra, creating blockage/difficulty urinating
peripheral zone of prostate
main glands, site of prostate carcinoma
*more serious
only benefit here is that is can be palpated during prostate exam
normal prostate should not be palpable during rectal exam
where oocytes are being produced
ovaries
uterus is found
posterior to bladder, superior to cervical region
infundibulum of uterine tube
where oocytes are received, have fimbrae or diner-like projections
cervix
connection between uterus and vagina
internal os on urerine side
external os on vagina side
vagina
walls extend superior above cervical os, creating pockets on either side of cervix
most common reproductive cancer in woman
ovarian (20,000 dealth/year)
8th most common cancer among woman
5th leading cause of death
in female pelvic cavity, there are two angles to the axes and repro organs...
between vagina and cervix- anterior bend creating the angle of anteversion
between cervix and uterus - angle of anteflexion
(in pregnancy, uterus can become retroflexed, causing back pain)
vesicouterine pouch
in females
created by reflections of peritoneum off fundus of uterus
rectouterine pouch
in females
created by reflections of peritoneum off recum and uterus
broad ligament
peritoneum
3 parts:
mesometrium - main lateral extensions
mesovarium - part attaching to ovaries
mesosalpinx - part attaching to uterine tubes
round ligament of uterus
extends from lateral aspect of uterus to lateral body wall, enters deep inguinal ring
suspensory ligament of ovary
runs from ovary to lateral body wall
contains the ovarian vessels
look for on left side -- find L.ovarian vein draining into L.renal vein, trace down to find suspen. ligaments
from hindgut on, have preganglionic parasympathetic fibers coming from
S2 3 4
from hindgut on, have postganglionic parasympathetic fibers coming from
Auerbach's plexus within wall of the GI tract -- only organized structure with post gang. nerve cell bodies in lower area
coccygeal plexus
S4-C0
mostly sensory nerves
sympathetic innervation of pelvis is via
superior hypogastric plexus (L5)
hypogastric nerves
inferior hypogastric plexus (S2-4 join)
general functions of sympathetic in pelvis
contraction of smooth muscle in internal urethra and anal sphincters
contraction of smooth muscle associated with repo tract and accessory glands
ejaculation (shoot)
ganglion impar
right on coccyx, where left and right sympathetic chains come together
at superior hypogastric plexus, we have....
sympathetic fibers descending into pelvis to innervate pelvic viscera
parasym fibers ascending up through hypogastric nerves and sympathetic plexus to hindgut
general function of parasympathetics in pelvis
vasodilation
bladder contraction
erection (point)
modulate activity of enteric nervous system of colon distal to left colic fixture
important in moving secretions from epididymis and associated glands into urethra to form semen during ejaculation
sympathetics
umbilical artery
anterior most branch off anterior internal iliac
runs up body wall and becomes ligament - medial umbilical fold
before becoming ligament - gives of superior vesicular artery
uterine and vaginal arteries
both off anterior internal iliac
uterine runs above ureter toward uterine wall
vaginal runs below ureter
obturator artery
off anterior internal iliac
follows obturator artery
exits via obturator canal
internal pudendal artery
off anterior internal iliac
exits through
erection -- the "point"
parasymp. relaxes helical arteries - they straighten causing cavernous sinuses to fill quickly
puts pressure on efferent veins that normally drain the tissue
more blood in-less blood out causes corpora cavernosa tissues to become engorged - penis is erect
erection -- the "shoot"
during climax, sympathetics contract helical arteries, making them spherical again and decreasing blood flow into cavernous sinuses,
less pressure now on efferent veins, begin to drain in pulsating manner
during erection, it is important to keep what tissue pliable
corpora spongiosum to allow urethra to remain patent so ejaculation is possible
labia majora is homologous to
scrotum
labia majora (begins & ends)
anteriorly- mons pubis, where fatty tissue is
terminates posteriorly as the posterior commissure which is most prominent before labor and delivery
labia minora terminates at
frenulum
infection can migrate from lower abdomen down to scrotum via
membranous fascia but NOT past thigh due to fascia lata
anal columns are formed by
superior rectal artery and vein
acts as sling on anal canal to put bend in it when we are not defecating
pelvic diaphragm
will relax during defecation so anal canal striaghtens
connection between endoderm and ectoderm in anal canal
pectinate line
how are targets of endocrine glands defined?
endocrine glands use vasculature to deliver message so target is defined by who senses the signal (who has receptors)
effect of hormone needs to be sensed by target...
at extremely low levels
autocrine
secretes factors which then bind to a receptor on that very same cell
juxtacrine
cell to cell signaling - cells are adjacent
paracrine
release in localized area but NOT into vasculature
endocrine gland that controls most other glands
pituitary gland
pituitary gland
sits in sella turcica, a cavity within sphenoid bone
surrounded by membrane that is actually part of brain
posterior pituitary
pars nervosa (neurohypophysis)
develops from floor of brain (diencephalon)
attaches to brain via infundibulum
anterior pituitary
adenohypophysis
forms from roof of mouth, Rathke's ouch
provides the endocrine portion of the pituitary
cells of parathyroid gland
chief cell (most abundent) - pale, acidophilic, irregular granules
oxyphil cells - larger, much less of them
function of chief cells in the parathyroid gland
secretion of parathyroid hormone
major hormone by which we regulate Ca
parathyroid hormone
parathyroid hormone function
increase serum [Ca+2]
parathyroid hormone targets
bone (interacts with osteoblasts)
kidneys tubule cells
GI tract
parathyroid hormone stimulates kidney tubule cells to...
increase: Ca reabsorption from PCT, phosphate excretion, activation of vitamin D
decrease: phosphate reabsorption
bone is formed when Ca and phosphate come together, thus when concentration are both high..
will form bone
bone is formed when Ca and phosphate come together, thus when you limit phosphate
Ca levels stay high, cant be used to form bone
increasing activity of vitamin D has what effect
increase Ca absorption in the gut
in males, bulbospongiosis meets at
midline of penis at the tendinous raphe
barium enema is used to look for
colon carcinomas and abnormalities
free air in abdomen can indicate
diverticula, duodenal ulcer, appendicitis
GOO - gastric outlet obstruction
(radiology)
characteristics: stomach significantly dilated, paucity (small amount) of bowel gas in large and small bowel
-can be caused by tumor
SBO - small bowel obstruction
(radiology)
indications: centrally located small bowel loops and visible air fluid levels
(fluid cannot go from small to large bowel)
can be caused by scar tissue post-surgery or peritonitis (infection)
LBO - large bowel obstruction
(radiology)
significant dilation of large bowel
most common cause - colon carcinoma
Ileus
(radiology)
temporary loss of motility of bowel
significant dilation of large and small bowel
most often seen post-op where there was manipulation of bowl during surgery
also high doses of pain meds
pneumoperitoneum
(radiology)
presents with free air within abdominal cavity
will see radiolucency beneath right and left hemidiaphragms, representing pockets of free air under diaphragm
normally seen post-op
with splenomegaly, you may see
stomach shifted midline
(organomegaly can effect neighboring organs)
cholelithiasis would present as
gallstones in right upper quadrant
also can be stone in kidney, termed renal calculi
calcifications in aorta would indicate
atherosclerotic diseease
dobhoff tube
feeding tube
smaller and more flexible than other NG tubes
no suction
best way to evaluate gall bladder
ultrasound and doppler
imaging technique with better organ and vascular definition
CT
imaging technique used to stage cancers of the colon
CT
biopsies and drainages can be performed with use of
CT
(biopsies can also be done using ultrasound)
imaging technique that helps differentiate cystic/solid masses
ultrasound/doppler
good way to rule out aortic aneurysm
ultrasound
imaging technique giving definition of structures in multiple planes and clarity between soft tissue and vasculature
MRI
in order to see air fluid levels, need to take..
decubitis or upright films
(prob will not see these levels in supine film)
abduct the toe digits
four dorsal interosseous muscles
adduct the toe digits
three plantar interosseous muscles
see air fluid level along with curved line along right heart border .. this is a presentation of
hiatal hernia
while barium study of esophagus may see "birds beak" which is
narrowing of distal esophagus
if you can see contrast in stomach you know there is not a complete obstruction
sometimes described as having a "feathery"appearance on films
small bowel
see small radiolucent area in intestines, may be
polyp
"apple core" lesion
circumferential mass within colon
calcaneal tendon
thickest and strongest in body
gastrocnemius and soleus use to insert on dorsum of calceneus -- these are the major plantarfelxors of posterior compartment
- tearing is very painful, can't plantarflex foot
plantaris
very small
posterior compartment - flexes leg and plantar flexes foot
injury here would not cause severe symptoms
popliteus
muscle on posterior knee
allows knee to rotate medially and unlock to initiate flexion of knee
innervated via tibial nerve
popliteal fossa contains
popliteal artery (deepest)
popliteal vein
common fibular nerve
tibial nerve
ischial tuberosity is the origin of
hamstrings
important for flexing leg and extending thigh
damage to lateral condyle of tibia may impair
dorsiflexion
tibialis anterior originates from lateral condyle and is responsible for dorsiflexion
sartorius originates on
ASIS
rectus femoris takes origin from
AIIS
normal ejaculate
3-5 mL
30-50 million sperm/mL
minimum sperm number
15 million/mL
anything below this iis consdiered infertile
connective tissue capsule of testis
tunica albuginea,
white shiny very dense
mediastinum testis
thickening where tunica albuginea invaginates and creates the connective tissue septa that subdivide testes into ~250 lobules
teste lobule
1-4 seminiferous tubules and interstitium
shape of seminiferous tubules
U-shaped
both ends open into rete testis
ducts of the testis
seminiferous tubules
rete testis
straight tubules (tubuli recti) - connecters of latter and former
form outer lining of seminiferous tubules
pertibular myoid cells
line lumen of seminiferous tubules
sertoli cells
cells in connective tissue surrounding seminiferous tubules
leydig
herniation of abdominal contents into thorax would most likely occur through what region
lumbocostal triangle
how does retus abdominis assist in respiration
depresses rib cage on expiration
have inflamed smaller intestine - where would the nerve cell bodies of the pain afferents from this be located?
T10 dorsal root ganglion
structure most likely to refer pain to epigastric region of anterior abdominal wall
head of pancreas
does NOT drain directly into IVC
left suprarenal
left gonadal
peritoneum lining lower anterior abdominal wall is called
parietal
damage to superior gluteal nerve would present as
hip drop on affected side
superior gluteal innervates gluteus minimus & medius important abductors of the hip, stabilize the pelvis when walking
injury to the femoral nerve would
weaken the quadriceps--the patient would not be able to extend his leg
injury to the obturator nerve would
impair adduction of the hip
Damage to the sciatic nerve would
paralyze the hamstrings and all the muscles in the leg and foot
Tensor fasciae latae is a
medial rotator
Biceps femoris is a muscle in the
posterior compartment--it's a hamstring muscle that extends the hip and flexes the knee.
cruciate anastomosis supply blood to
area around the head of the femur
there is a weakness when climbing steps or jumping, you should know that there is a problem with
powerfully extending the hip--gluteus maximus
Iliopsoas is a
hip flexor
hamstring muscles
innervation
origin
action
biceps femoris
semitendinosis
semimembranosis
originate from ischial tuberostiyy
All innervated by tibial nerve EXCEPT short head of biceps formis which is innervated via common fibular nerve
action: extension at the hip, flexion at the knee
Leydig cells
interstitial cells in seminiferous tubules
produce primarily testosterone (also estradiol)
regulated by LH via pituitary
very important in creating the blood-testes barriers
tight junctions between Sertoli cells
around puberty, spermatogenesis beings and developing spermatocytes will have surface proteins never seen before by immune system - need barrier to prevent lymphocytic attack
some men produce anti-sperm antibodies -- this could be an indication of
infertility
women may also have immune response to sperm in reproductive tract, another explanation of infertility
seminiferous epithelium
unique arrangement of sertoli and spermatogenic cells
job of sertoli cells is to
-support development of spermatozoa - nutrition, move and release into lumen, phagocytosis.
-secrete MIS
-created blood-testes barrier
characteristics of sertoli cells
columnar - developing sperm cells located in pockets of their cytoplasm
secrete protein - lots of rough ER/extensive golgi complex
non-proliferating in adults
regulated by FSH
in developing male, FSH stimulates
sertoli cell proliferation
number of sertoli cells present is roughly proportional to
number of sperm produced
animal models have shown their are various factors that can inhibit sertoli cell proliferation, thus leading to
reduced sperm count in adulthood
potential to produce sperm is much greater than number
produced -- what is the a monitoring system in seminiferous tubules that detects malformations/mistakes
sertoli cells - monitor and will phagocytize any mistakes
MIS (mullerian inhibiting substance)
produced by sertoli cells to inhibit development of mullerian ducts
if no MIS is present - defult female mullerian ducts develop
tight junctions between Sertoli cells divide...
seminiferous epithelium into basal and adlumenal compartments
most abundant protein secreted by sertoli cells
clusterin - found often in areas of pathology (kidney/cardiovas.disease, alzh. disease)
believe Clusterin tries to break down insoluble parts of cells -- Sertoli cells break down cell components they are phagocytizing
one of sertoli cell's secretions is inhibin, which will
decrease levels of FSH
feedback mechanism- responds to FSH levels and tells pituitary to stop secreting it
What are the secretions of Sertoli cells
transferrin (iron transport)
androgen binding p. (testost. transport)
collagen IV and laminin (BM components)
MIS, inhibin, clusterin
in seminiferous tubules, any round cellsitting on basement membrane -- consider it a
spermatogonia
primary spermatocytes
coiled and condensed nuclei - long prophase of 1st meiotic division
immediately go through meiosis I and II to produce spermatids (haploid) (very short time as secondary spermatocyte)
spermiogenesis
maturation of type A spermatogonia into mature spermatozoa
approx. 64 days
MUST be 35 deg. C (little color then reg body temp)
when spermatozoa are released, excess cytoplasm
is release as structure call the
residual body -- most of which is phagocytized by Sertoli
developing male germ cells become adlumenal at what stage?
primary spermatoyctes
how is critical 35 deg. C temp achieved during spermatogenesis
pampiniform plexus of veins
cremaster muscle (relaxes - scrotum sits lower)
dartos muscle (insulator around scrotum)
spermiogenesis
form acrosome
condense and elongate nuclei
develop flagellum
loose most of cytoplasm
put mitochondria right as base of flagellsa
significance of the estrogen receptor male knockout mouse
it was infertile
indicated that estrogen does have a role in male development
have also found that men with mutation in estrogen receptors have infertility issues
pituitary-testicular axis
axis between pituitary and gonad - feedback mechanisms (i.e. inhibit) help to regulate FSH and LH levels
released from anterior pituitary, stimulates synthesis of androgen in testes
LH
provides the negative feedback of androgen on hypothalamus from testes
leydig cells
straight tubules of the testis
lined by simple cuboidal epithelium of sertoli-like cells
looks very mush like a seminiferous tubule except no sperm
rete testis
anastomosing channels in mediastinum testis
lined by simple cuboidal epithelium
function of efferent ducts
absorb testicular fluid
transport sperm from testis to epididymis
(H2o pressure system moves sperm to rete testis and epididymis - efferent ducts remove some of this fluid)
characteristics of efferent ducts
about 12 of these are connecting rete testis to epididymis
epithelium of principal cells w/sterocilia and low cuboidal cells -- creating this alternating epithelium
thin layer of smooth muscle to help move sperm
function of epididymis
absorb testicular fluid (drawing sperm toward it)
phag. degenerate spermatozoa and resid. bodies
change plasma membrane of sperm
STORE SPERM in tail
where do sperm become motile
epididymis
sperm analysis-- what are some criteria for wither or not sperm is fertile
can it move?
can is move in straight line? -- malformed flagella can cause sperm to go in circles
characteristics of epididymis
single tube (uncoiled-4 to 6M)
pseudo. columnar with sterocilia (NOT cilia but long microvilia - not motile but increase surface area)
circular smooth muscle
vas deferens function
gets sperm from epididymis at ejaculation
moves it to prostatic urethra
ampulla at distal end leads to prostate gland
vas deferens struture
psudostratified columnar
3 layers of smooth muscle
(looks like flower)
ejaculatory ducts
formed by seminal vesicle and vas deferens
open onto posterior wall of prostatic urethra
simple columnar epithelium
function of seminal vesicles
produces alkaline viscous fluid w/ fructose -- gives energy to sperm and prostoglandins
this fluid constitutes 70% of ejaculate
(10% of ejaculate is from testes, 20% from prostate)
produce the fructose that sperm use as energy source for moving through female repo tract
seminal vesicles
seminal vesicles structure
2 highly tortuous tubes
folded muscosa, simple cuboidal/pseudo. columnar
thin layer of smooth muscle
outer coat of fibrous connective tisse
function of prostate
decrease viscosity as it adds its secretions to semen
structure of prostate
capsule
30-50 branched tubuloalveolar glands
squamous to pseudo columnar
fibromuscular stroma surrounds glands
found in luman of glands in prostate
prostatic concretions -- corpora amylacea
function: help students identify prostate on practical
bulbourethral gland
secretes mucous with lots of sugar and sialic acid
lubricates/prepares urethra for sperm passage
found in urogenital diaphragm
opens into penile urethra
to distinguish large/small bowl on abdominal CT
small bowel has markers (haustra) closer together and smaller luminal diameter
CT - how to distinguish vessel from ducts
vessels increase with contrast
"brown glass" appearance of CT
hazy, difficult to ID margins of organs such as liver and spleen
common causes of this are ascites (fluid buildup)
identifying abscess vs. cyst
cyst is seen as area of decreases density with crisp, defined borders
abscess will not have such defined borders, may also see air bubble which suggests infective process
tail of pancreas should be in close proximity to
hilum of spleen
when looking for head of pancreas on CT...
look for contrast filled bowel, which is the 2nd portion of duodenum
gallstones that are "faceted" stones
have sharp angulated margins due to rubbing against each other for a while
how to ID gallstones using ultrasound
bright areas are stones - stones have acoustic shadowing
deviations of ureters on CT could indicates
tumorous mass
wont always see the mass so you look for the mass's effects
using ultra sound to look at kidneys, see dilated calices and darker areas -- could indicate
blockage preventing urine from leaving kidney
using ultra sound to look at kidneys, see splayed calyx may suggest
mass effect
could have cyst causing deviation of calices
How will a cyst appear with contrast?
will not be enhances by contrast, fluid is stagnant thus not in contact with vasculature
histerosalpingogram
used to check women's repro structures (esp if having trouble getting pregnant)
contrast is added into vagina and through cervix
*want to make sure patient is not actually pregnant before performing
male: see impression on inferior border of urinary border...
enlarged prostate
retrograde urethragram
contrast added retrograde into penile urethra, looking for congenital problem/trauma to urethra
a portal system is..
two capillary plexuses connected by veins
female primordial germ cell -->
oogonia - primary oocyte - ovarien follicle - primordial follcile - primary follicle (unilaminar then multilaminar) - secondary (antral) follicle - mature graffian follicle
after ovulation -> corpus luteum - corpus albicans
ovarian cortex
business end of ovary
germinal epithelium
tunica albuginea (just beneath the epithelium)
primordial follicles
primordial follicle contains..
primary oocyte - stuck in prophase I
around primary follicles
single layer follicular cells - continuous basal lamina basically wrapping around the primary follicles
unilaminar primary follicle
FSH has stimulates rapid oocyte growth
have mitosis of follicular cells creating a single layer of granulosa cells
multilaminar primary follicle
follicular cells continue to divide, making serveral layers of granulosa cells
have thin rim forming between oocyte and granulosa layer -- this is zona pellucida
zona pellucida
made of glycoproteins
rim between oocyte and granulosa layer
NECESSARY for proper acrosomal activation
*thus critical in fertilization
granulosa filipodia
membrane extensions of granulosa going through zona pellucida, communicating with microvilli on surface of oocyte via through gap junctions -- allow epithelium to respond in unison
Antral follicle, granulosa cells....
start secrete follicular fluid
fluid pushes granulosa to periphery and create cumulus oophorus
fluid-filled spaces become antrum
corona radiata forms
follicular fluid (liquor folliculi)
lots of steroids: progesterone, androstenedion, estrogen
also hyalutonate, growth factors, fibrinogen (anticoagulant), HS proteoglycan
corona radiata
right up against zona pellucida ?
during antral follicle stage, stromal cells ...
arrange in to follicular theca (coat)
theca interna (endocrine) and theca externa (fibrous)
theca interna during antral follicular phase
endocrine
produces androstenedione - precursor of steroid hormones
anatomic snuff box is bound by
"brevis sandwich"
abductor pollicis longus
extensor pollicis brevis
extensor pollicis longus
bone lying in the floor of anatomic snuff box
scaphoid
fall on outstretched hand will present has
swelling in snuff box
most commonly fractured carpal bone
scaphoid
artery that can be found within anatomic snuff box
radial - can palpate pulse here
innervation of lumbricals (in the hand)
1 and 2 - median
3 and 4 - deep branch of ulnar
dorsal interosseous muscles
4 bipennate muscle
innervated deep palmer branch of ulnar
ABduct fingers from middle finger
palmer interosseous muscles
3 unipennate muscles
innervated deep branch of ulnar
ADDuct finers to middle finger
fracture to surgical neck of humerus is common.
what may be injured here?
axillary nerve
mid-shaft fracture of humerus - risk injuring
radial nerve
maturation from primordial to graffian follicle takes
90 days
mature or pre-ovulatory follicle
granulosa layer thins
thecal layers thicken
follicle is actually prtruding from surface of ovary
menstral cycle begins with
pituitary releasing FSH
corpus luteum
whats left in ovary
formed by theca interna and granulosa cells
controlled via LH - change their function/morphology
become granulosa lutein and theca lutein cells
when the egg is pushed into oviduct after the LH surge, it will be at what stage?
secondary oocyte (haploid) (arrested in metaphase II) with first polar body
most of the corpus luteum is composed of what cells?
granulosa lutein
responsible for aromatase conversion of androstenedione to estradiol
corpus lutem cells arranged in 'strands' or lines, less numerous
theca lutein
produce progesterone and androstenedione (keep uterus happy and ready for pregnancy)
hormone responsible for maintaining integrity of uterine wall so it is ready for implantation
progesterone
when corpus luteum ceases steroid production, undergoes apoptosis, phagocytosis - a dense scar tissue forms called...
corpus albican
what will induce actual menstration (sloughing off of functional layer of endometrium of uterus?)
decreased progesterone
as corpus luteum is dying, estrogen levels are reduced, this allows for...
FSH to stimulate a new group of follicles to begin the cycle again
hormone responsible for maintaining corpus luteum
LH
if pregnancy occurs, the corpus luteum ...
maintains uterine mucosa
halted in progesterone production by HCG (?)
becomes very large over 4-5 months until placenta takes over progesterone and estrogen production
becomes corpus albicans
progesterone role in pregnancy
thickening of endometrium(main)
stimulate breast tissue growth
strengthen cervical mucus plug
prevents uterus from contracting
38-42 weeks - levels will drop, stimulating contractions of uterus
levels a doctor will look at to make sure proper environment is being prepared for fetus development during pregnancy
progesterone
normally there is a spike in FSH at beginning of mentral cycle, very high levels of FSH could indicate
follicles not responding properly to FSH,
pituitary keeps throwing out more FSH b/c oocytes are not growing properly -- 15-20% chance of pregnancy
placenta
fetuses contribution
forms early in pregnancy
connects fetus to moms uterine wall
main components of placenta
villous parenchyma (can help distinguish preg. stage)
maternal decidual tissue
placental membrane
2 layers
amnion - innermost lining of amniotic cavity, single layer flat epithelial cells
chorion - connective tissue - carries fetal vasculature
decidua
maternal contribution
large, pink cells derived from uterine stromal cells
essential for implantation and establishing fetal-maternal communication
first trimester villi
two layers trophoblast cells
stroma loose connective tissue
small fetal blood vessels
second trimester villi
smaller/thinner trophoblast layers
compact stroma - collagenous
larger fetal capillaries - towards the edge
third trimester villi
smaller, tight knot-like
stroma thin strands btw dilated fetal capillaries whic fuse with thinned trophoblast layer
site of exchange btw fetal and maternal circulation
oviduct has 4 sections;
infundibulum (closest to ovary - where egg is released into)
ampulla
isthmus
intramural (uterine)
oviduct function
thick muscularis of interwoven spiral and longitudinal sm moves embryo
mucosa provides protective/nutritive environment for oocyte/sperm/embryo
wall of oviduct characteristics
folded branching mucosa
thick muscularis of interwoven spiral and longitudinal sm thin serosa (can touch)
oviduct epithelium
simple columnar
ciliated and non cells
secretory peg cells
estrogens of follicular phase promote cili elongation and secretion
late luteal phase - loose cili/atrophy
capacitation
process that creates fully mature sperm capable of fertilizing ovum
Peg Cells
secrete glycoprotein in oviduct
provides nutritive/protective environment as sperm travel
facilitate sperm capacitation
support ovum until/when fertilized and embryo during initial stages of development (as it tumbles down to uterus)
fertilization usually occurs...
ampulla of oviduct
what triggers oocyte to complete 2nd meiotic division
fertilization
time it takes for zygote to travel to uterus
~ 5 days
ectopic or tubal pregnancy can be caused by
scar tissue blocking uterine tube
3 layers of uterus
perimetrium - connective tissue, outermost
myometrium - vascularized smooth muscle
endometrium - simple columnar epithelium (business end of uterus, simple columnar will be in various stages of growth)
endometrium - basal layer
basal ends of uterine glands and highly cellular lamina propria
on day 1 of menstrual cycle, endometrium of uterus
sloughing off functional layer -- blood from ruptured vessels
menstrual period lasts 3-4 days
followed by proliferative phase (8-10) and then secretory phase (14+) which begins at ovulation
allow for inversion and eversion at foot
subtalar joint ( talus + calcaneus)