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200 Cards in this Set
- Front
- Back
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what is herniated through in an indirect vs direct hernia?
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indirect- vaginalis process
direct- hesselbeck's triangle |
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what are the borders of hesselbeck's triangle?
where does the vaginalis process come out of? |
rectus abdominus
inferior epigastric inguinal ligament inguinal canal |
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pic of layers herniated in a direct
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pic of layers herniated in an indirect
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what layer is under the skin in the scrotum? what does it originate from?
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dartos fascia from the scarpa's fascia
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what is the process vaginalis from?
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the parietal [peritoneum
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which is more superficial, transversalis or parietal peritoneum?
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transversalis fascia
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name all the original layers in the abdominal wall 8
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1. camper's fascia
2. scarpa's fascia 3. external oblique 4. internal oblique 5. transversus abdominus 6. transversalis fascia 7. properitoneal fatty layer 8. parietal peritoneum |
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name what these 8 turn into when the testes descend down
1. camper's fascia 2. scarpa's fascia 3. external oblique 4. internal oblique 5. transversus abdominus 6. transversalis fascia 7. properitoneal fatty layer 8. parietal peritoneum |
1. camper's fascia - dartos
2. scarpa's fascia - colle's fascia 3. external oblique - external spermatic fascia 4. internal oblique - cremaster muscle 5. transversus abdominus- skipped 6. transversalis fascia - internal spermatic fascia 7. properitoneal fatty layer - skipped 8. parietal peritoneum - process vaginalis |
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which layers surround the testes?
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everything except the tunica vaginalis
dartos, colles, ext sperm, cremaster, int sperm |
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why does it make sense that the testes don't go through the tunica vginalis?
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because they develop extra peritoneal
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where is the femoral hernia? what is it between? under?\
mnemonic |
in the empty space between the femoral vein and the lacunar ligament (NAVEmptyL)
under the inguinal ligament |
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what does an obturator hernia look like? what is the hernia between? why this exact spot?
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inside the obturator foramen opening that isn't covered by fascia
between the front of the obturator foramen and it's fascia |
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what demographic gets obturator hernias? why do you think?
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women, esp ones who have had a lot of abdominal pressure like pregancy and obesity
their pelvises are more open and the obturator foramen is more in the coronal plane |
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how are obturator hernias usually diagnosed?
as seen on the young and the restless! |
pts complain of an intestingal obstruction ad then they find it while doing surgery
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What sign indicates an obturator hernia? Why?
mnewmonic? |
Howship-Romberg sign- inner thigh pain on internal rotation because the obturator nerve gets compressed
Howship= Howl being shy and internall rotating his thigh Romberg- something neural |
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what general action causes pain with an obturator hernia? root cause?
3 specific motions? |
anything that stretches the obturator foramen/pelvis awak from the front midline close to the intestines.
hip extension abduction internal rotation |
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what 2 frontal hernias are more likely to happen to women?
what one is more likely for men? |
women- obturator and femoral
men- indirect inguinal |
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what is an incisional hernia?
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any hernia going through a wealkened muscle/CT from surgery
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how can you auscultate a hernia possible?
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see if you hear bowel sounds in the protrusion
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pathophysiological consequences of an incarcerated hernia? 5 steps
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incarcerted hernia --> ischemia --> death and hemorrhage from backing up blood --> bowel explodes --> contents cause chemical or infectious peritonitis --> death
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what thing can you do physically to check if a hernia is incarcerated?
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try to reduce it and if you can't then it may be incarcerated
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how many stars in genital embryology?
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4 stars!
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which duct become the male organs and the female? alternate names
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male- mesonephric/Wolffiian
female- paramesonephric/Mullerian |
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what is the default development path?
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toward the female
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what gene and protein product makes you male?
mnemonic? |
SRY gene and Testes Determining Factor
Sorry! You are gonna be a boy! |
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what does the testes determining factor do? 2
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it develops cells into the sertoli and leydig cells
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What do the sertoli vs leydig cells do to encourge further male development?
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they both produce male hormone
sertoli- antimullerian hormone leydig- testosterone |
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What does each hormone do to further male development?
sertoli- antimullerian hormone leydig- testosterone |
sertoli- antimullerian hormone- degeneration of mullerian ducts
leydig- testosterone - development of wolffian ducts into male internal reproductive organs |
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what indirect thing does testosterone do to enocurgae male development? where does this happen?
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it gets turned into DHT at the periphery to mature the external genitalia
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what happens to boys without sertoli cells developmentally anatomically?
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they have all male parts, but also male and female internal reproductive organs
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what is the inside and outside appearance of a baby born with 5-alpha reductase deficiency?
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internally male, but externally ambiguous
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are these 5aR deficient boys doomed to ambiguous genitalia forever?
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no, when pubertyy hits, there is enough testosterone to help them develop it
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what do the mullerian ducts develop into?
the wolffian? |
m- upper 1/3 of vegina, uterus, tubes
w- ductus deferens, epididymus, seminal vesicles, ejaculatory duct (everything but prostate) |
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what does the urinary bladder contribute to women and men in development?
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women- 2/3 of outer vagina
men- prostate gland |
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what do you get if there is imcomplete fusion of the mullerian ducts?
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bicornuate uterus
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what 2 things are associated with bicornuate uterus?
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other reproductive tract abnormalities and infertilitya
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what type of infertility with the bicornuate uterus exactly? why?
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frequent miscarraiges because the container for the baby isn;t right
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least to most severe example of bicornuate uterus?
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least- little septum in the fundus
most- end up with two cervixes |
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homologues! 4 star topic
female counterpart to male... glans penis corpus spongiosum bulbourethral glands prostate gland penis shaft scroum |
glans penis- clitoris
corpus spongiosum- vestibular bulbs bulbourethral glands- bartholin's glands prostate gland- skene's glands penis shaft- labia minora scroum- labia majora |
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what helps the external genitalia differentiate into male vs female?
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DHT and estrogen
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what do undifferentiated genitals look like?
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alternate name for gland of Skene?
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urethral and paraurethral glands
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alternate name for bartholin glands?
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greater vestibule glands
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what does the inside of the clitoris look like?
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what do the vestibular bulbs look like and what external thing do they create during sex?
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they are responsible for the female genitalia becoming engorged during sex
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what are the orders of the 3 stages of reproductive development?
name the week they are completes too |
1. gonadal development - week 8
2. duct development 3. extternal genital |
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name the steps of the sertoli cell's development and subsequent role in sex differentiation
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SRY --> testes differentiation factor --> testes develop --> sertoli cells create MIF --> mullerian degeneration
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name the steps of the leydig cell's development and subsequent role in sex differentiation
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SRY --> TDF --> leydig -->
1. testosterone - differentiates Wolffian ducts to become internal reproductive structures 2. DHT- masculinization of external genitalia |
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What involutes the Wolffian ducts in females?
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the abscence of testosterone
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what strutures does the urogenital sinus become in men? female homologs?3
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corpus spongiosum- vestibular bulbs
bulbourethral glands- bartholin's glands prostate gland- skene's glands |
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what does the urogenital fold beocme in males and females?
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the penis shaft and the labia minora
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what did the scrotum come from in the undiff state?
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labioscrotal swellings
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what is the explanation for a girl all of a sudden developing a penis during puberty?
what congenital abnormality does she have? |
5-alpha-reductase deficiency that made her external genitalia undifferentiated (no DHT) until the testes produced more testosterone in puberty
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in development, are the mesonephic or paramesonephric connected to the gonads? how do you know?
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the mesonephric because the epidydimus is inserted into the testes
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why are some sex accesory organs in the male from the urogenital sinus?
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because the urogenital sinus takes over the tube system at a certain point
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what are these parts?
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where does the ductus deferens carry sperm to and from?
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from epididymus to the ejaculatory duct
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what the the ductus deferen's path to the prostate?
what does it have to go through? relation to bladderr? ureters? |
up the back scrotum through spermatic cord and inguinal canal
over the bladder and medial to the uretersto insert in back of prostate. |
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location of seminal vesicles in relation to DD? prostate?
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on prostate lateral to DD
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how are you able to palpate the prostate in a digital rectal exam?
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in a bladder cross section, how do the seminalvesicles, DD, and ejaculatory duct actually meet? boundaries of the ejaculatory ductt?2
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within the prostate in the ejaculatory duct
starts at the end of seminal vesicle and DD end at the prostatic urethra tube |
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name the 4 sections of the urethra
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preprostatic
prostatic membranous spongy |
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explain the naming for each
preprostatic prostatic membranous spongy |
first 2 are obvious
membranous- no sponge or prostate around it spongy- the corpus spongiosum is guiding it along the penis |
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how many ejaculatory ducts do we have?
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2 - one on each side
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what is around the membranous urethra? 2
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the external uretal sphincter and the deep perineal pouch
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where do the bulbourethral glands sit in relation to the tubes? to the prostaate?
how many of them are there? shape? |
in the deep [erineal pouch under the prostate
behind and lateral to the spongy urethra 2 tiny round bulbs |
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figure out the 4 urethral parts, the 2 sphincter locations, and the cowper's glands here
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what do you see here? 4 different structures and label them.
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what does each of the 3 holes in the uretal crest do?
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prostatic utricle- nothing- it is a blind pouch
ejaculatory ducts- where semen comes in |
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what is the seminal colliculus exactly?
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that circular swelling on the uretal crest
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function of the internal uretal sphincter?
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to prevent semen from going into the bladder
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what 3 tubes make up the penis? what do they look like? (don't count urethra)
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how do you know the corpus spongiosum is in the middle?
is it in the middle on top or bottom? how do you know? |
the SPONGY urethra is named that for a reason
it forms the bulby base of the penis |
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what does the inner end of the corpus cavernosa look like? what are these called?
give their specific attachments what does the end of the corpus spongiosum lok like? (in same pic) |
they attack to the ischial rami
spongiosum is round |
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sigular for crura?
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crus
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what forms the glans of the penis?
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the corpus spongiosum (anatomy zone was wrong)
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what is the proximal part of the corpus spongiosum called and what other 2 structures are here?
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what structures form the root of the penis"?
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all 3 proximal structures
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what is the body of the penis?
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all 3 tubes in the shaft
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what are the 2 ligaments that attach the penis?
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the fundiform and the suspensory
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which ligament allows guys to move the penis? it's attachments?
mnemonic? |
they have fun with this
connect from linea alba to a sling around the base |
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where does the suspensory ligament attach? mnemonic?
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it does a lot of the everyday grunt work of suspending the penis
from pubic symphysis to the base of the penis |
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which penis ligament is more superficial?
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fundiform (it is in the linea alba!)
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now to female external anatomy
what holes does the labia minor cover aorund? |
fold around glans clitoris and wholly around urethra and vagina
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what does the labia majora connect to in front and back explain each.
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front- mons pubis- pad of fat in front of pubic symphysis
back- posterior commissure- depression that is connection between anus and vagina |
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how does the labia minora accomodate the clitoris?
what structures does it become and give 2 names for each |
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common name for prepuce?
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clitoral hood
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how do you remember frenulum?
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it is the ventral side of the penis homolog
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in a male, what are the lateral and medial folds of the labia minora?
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the foreskin!
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what is the back joining of the labia minora called?
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fourchette
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what is the vestibule?
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the whole thing in the labia minora
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what is the hymen? does it cover the whole vagina?
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sometimes.
it's a membrane that is in the vagina orifice |
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another name for the vaginal orifice?
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where are the bartholin's glands? alternate name?
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posteriolateral sides of introitus
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where is the female version of the prostate? 2 names?
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or skene glands
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what is the endo and ecto cervicx?
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show where the different cells meet and give the name of thiis junction
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what happens to the squamocolumnar junction during puberty?
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the endocervix moves out
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what exactly is the transformational zone? does every girl have it?
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when the columnar epithelium are exposed to the acidic environment during puberty, they metaplase. this is the zone of transformation only in post pubertal girls.
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why is the transformational zone so important?
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this area is most susceptible to neoplastic change because it is close to dysplasia
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function of bartholin glands?
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to secrete mucus to lubricate the vagina
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what structire in the male secretes prostaglandins and fructose?
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seminal vesicles
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how much of semen do the seminal vesicles provide?
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70%
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what is an ectropion? show and explain.
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when the endocervix comes out to the vagina
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Is cervical ectropion normal? what complications can arise from it besides cancer?
Why does this happen? |
it can bleed during sex because the columnar epithelium are highly vascularized (just look at the reddness!)
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how can you tell the different between normal cervical ectropion and cervical carcinoma?
how do they both look? |
they look the same, but you can do a cell smear to look for dysplastic cells
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is the only physical change in cervical ectropin the movement of the line?
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no, the tip also protrudes out a bit
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what is the name for a cervical dysplasia?
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cervical intraepithelial neoplasia (CIN)
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when does thee dysplasia become carcinoma?
what is it called? |
when it invades the basement membrane
cervical carcinoma |
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what are the 3 levels of seriousness of CIN?
definitions of each? which is most severe? |
CIN most severe and heads toward the surface
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why does dysplasia start from the basement membrane first?
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because those are the cells creating new cells
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what is carcinoma in situ? mnemonic?
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cancer before it has invades through the BM into surrounding tissues
it is inside the situation |
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main cause of CIN?
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HPV
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what are the 2 types of CIN? % of each?
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squamous cell- 90%
adenocarcinoma- 10% |
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how can you divide vagina/uterine prolapses into 3?
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the anterior, middle, and posterior compartment
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What structures can prolapse from the anterior compartment? names of these prolapses?
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bladder- cystocele
ureter- uretocele |
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what are 3 middle wall vaginal prolapse?
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uterine prolapse
enterocele vaginal vault prolapse |
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what are the 3 grades of uterine prolapse and what defines them?
give any alternate names that apply? |
grade 1- in vagina
grade 2- up to introitus grade 3- outside - procidentia |
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what are some causes of uterine prolapse? 4 and explain each
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1. pregnancy- large pressure and stretching out ligaments
2. post menopausal- ligaments are more lax from collagen destruction 3. obesity- pressure from abdomen pushing uterus down 4. iatrogenic- damaged ligament from pelvic surgery |
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what does an enterocele look like? where is it most likely to come from and why?
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pouch of douglas because it is most vertical
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what is a cause of enterocele?
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weak palvic ligaments, obesity, weak pelvic floor
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what can cause a vaginal vault prolapse? why?
what does it look like? |
a hysterectomy because them the uteris isn't there to hold the vagina up anymore
the vagina inverts on itself |
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wht is the pnly thing from the posterior wall to prolapse? how do you know it is just one?
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the rectum hugs the entire poserior side
rectocele |
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what are two common benign, but pathological causes of menorrhgia? what do they have in common?
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2 common benign tumors in the uterus
fibroids intrauterine polyps |
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why are causes of menorrhgia most likely in the uterus?
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because this is the place that causes menses (the bleeding and shedding)
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where are uterine fibroids located?
what is another name for them? dissect? |
the myometrium
uterine leiomata (smooth muscle tumors of the uterus) |
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3 types of uterine fibroids?
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what is menorrhagia?
dysmenorrhea? |
menorrhagia- heavy bleeding during periods
dysmenorrhea- painful menstruation |
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can fibroids cause dysmenrrhea? why?
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YES! you are contracting with a big lump in your muscle- that would be painful anywhere
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what are some urinary sx that uterine fibroids can cause? why/how?
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frequency and urgency if they are large enough to put pressure on the bladder.
retention if they are enough to block the bladder |
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what are intrauterine polyps like histolgically?
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they grow out of the endometrium and into the uterine cavity
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why may polyps cause menorrhagia?
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same reason as colonic polyps do.
also remember the endometrium is very highly vascularized |
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besides menorrhagia, what other sx do intrauterine polyps cause? why?
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intramenstrual bleeding because they can rupture at anytime
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what are some areas that endometriosis likes to affect?
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what is one complication of endometriosis of the ovary? names?2 appearance?
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endometrioma or chocolate cyst- when blood accumulates under the ovarian capsule
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can you leave an endometrioma alone? why?
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NO! the blood has nowhere to drain so it will eventually burst all over the pelvic cavity
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pic of a ruptured chocolate cyst?
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how does endometriosis happen? are you born with it?
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no, some endothelial tissue seeds to a new place during menses
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chronically, what sorts of things can endometriosis cause? why?
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adhesions and fibrosis from inflammation of blood being where it shouldn't be and breaking down there
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what is bad about adhesions?
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things are immobilized when they need to be dyanmic to move with the rest of the body
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what is it called when you get endometrial tissue in the myometrium?
wha does it look liek? |
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sx of adenomyosis?
how are these complications different than other locations of endometriosis? |
you may get dysmenorrhea and menorrhagia
no firbosis or adhesions because it is in the uterus |
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what is the most common malignancy of the female reproductive tract. why do you think this is?
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the endometrium is constantly growing and stuff. it is easier to slip up here.
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what is the biggest factor causing endometrial adenocarcinoma? why?
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prolonged estrogen unopposed by progesterone
estrogen is proliferative = cancerrrr |
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OK now we start the pelvic floor lectures (2)
what cmpartments does the pelvic floor separate? |
the peritoneum from the perineum below
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what two muscles make up the posterior and anterior wall of the pelvic cavity? show and name
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piriformis - posterior
and obturator internus- anterior |
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where do the piriformis and obturator interus attach distall?
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piriformis- greather trochanter on top
obturator internus-greater trochanter posteriorly |
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how do the piriformis look in 3D?
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reaches from the sacrumish to the front where the femur is
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what makes up the pelvic floor? 3
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what component is often used interchangably with pelvic floor?
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pelvic diaphragm
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what two muscles make up the pelvic diaphragm?
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what does the pelvic diaphragm look like in the saggital plane?
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a big dome
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show the obtuatr internus
what does it attach to in the pelvis? |
the medial part of the obturator membrane at the pubic side of the opening
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how does the obturator internus reach to the femur? what does it have to pass?
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passes under the ischial spine and wraps around the same level back to the greater tuberosity
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what do they meanby obturator internus vs externus?
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which side of the obturator membrane they attach from
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where are the other hip stabilizers in relation to the obturator internus?
gemelli and quadratus? |
they start more posteriorly so don't need to wrap around as much
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what angle do the obturator forament form from the body? what direction do they face?
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wide angle toward the back (back bowl)
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show the obturator internus in relation to the pelvic cavit
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what is wrong with this pic?
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the levator ani doesn't actually extend that far up
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where do the levator ani connect anteriorly and posteriorly?
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anterior- membrane of obturator internus
posterior- coccygeal bone |
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what is that hole in the frot of the levator ani? what does it do?
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females- lets vagina and urethra pass
males- just urethra |
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describe and show the 2 parts of the pubococcygeus
why are they considered the same muscle kinda? |
the main part connects the front pubic bone with the tailbone
the front one forms a sling around the urogenital hiatus they are still in a sheet |
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what is that anterior parts of the pubococcygeus called in men vs women? function?
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king of like a sling for either the prostate or the vagina
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what ligament goes down the middle of the levator ani?
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what are the intermediate fibers of the levator ani? why is it special?
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the puborectalis- it doesn't connect to the coccyx
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show the posterior fibers and name them. levator ani
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iliococcygeus
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what is the attachment point of the levator ani to the obturator internus called?
what does it look like? |
a thickened tendon line caled the tendonous arch
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what boney landmark does the tendonous arch begin and end at?
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bottom of pubic symphysis to ischial spine
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where does the coccygeus insert? 2
in relation to the levator ani? |
from the edge of the levator ani tendonous arch at the ischial spine to...
the part of the coccyx above the levator ani |
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what is the location and function of the perineal body?
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it is at the posterior arch tip of the urogenital hiatus and functions to connect the pelvic diaphragm with the perineum
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what are some of the great fiunctions of the pelvic floor in general?
the sling muscles? |
keeps out intestines and pee from falling out from the intraabdominal pressures (esp with sneezing)
thhe sking muscles also help to keep the rectum and vagina closed |
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what nerve controls the levator ani?
spinal levels? mnemonic? |
S 2, 3, 4 keeps shats off the floor (puborectalis)
pudendal nerve |
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show the coccygeus from the back
how long is it compared to the levator ani? how do you know? |
not as long because it only goes to the ischia spine which is the shortet any levator ani goes (not counting slings
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difference between the rectal and urogenital slings?
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one holds the rectum back
other holds the urethra/maybe vagina forward |
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what nerve controls the coccygeus?
spinal levels? mnemonic? |
S 4,5 anterior rami
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how do you remember the shats off the floor mnemonic only applies to levator ani?
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because the coccygeus only forms the back wall of the pelvic diaphragm and doesn't have the same power to hold stuff inside your tubes
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describe the oritation of the deep perineal pouch and perineal membrane in relation to the pelvic diaphragm?
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the membrane is below it and the pouch is the space between
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is the perineal membrane just a membrane?
what are it's attachments and shape? |
no, it is a muscle that attaches like a triangle to the front pubic arch, but stops at the ischial tuberosity and has a free edge
it also has orifices for anything urogenital to pass through |
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how does the perineal membrane look different in males than females? 2
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the angle would not be as wide and there would be no vaginal orifice
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does the perineal membrane go up to the tip of the pubic arch?
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no
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what is in the pelvic diaphragm directly above the urethral and vaginal orifices for the perineal membrane?
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the urogenital hiatus... so nothing
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show what the uterus and bladder look like sitting in their places
where are they located relative to the pelvis? |
uterus is right at the pelvic brim peaking over our pubic crests and the bladder sits right behind the pubic symphysis
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what is in the perineal pouch? space?
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it is a collection of muscles
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what innervates all the deep perineal puch muscles?
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pudendal nerve
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how much space in in the perineal pouch?
is it closed off? how? |
not much space and it is open in the fromt and back because the perineal membrane leaves those spaces
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how is the perineal membrane angled?
how much of it would you see if you looked straight down at it? |
very steeply angled toward the front
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what does this perineal membrane angle explain about feamle anatomy?
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why our urethra and vagina tend to face the front
(desbite our pubic symphysis being so low) |
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where does the perineal body connect to the perineal membrane?
what does this mean for positioning? |
the perinela membrane ends where the urogenital hiatus ends
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what are the 2 deep perineal muscles that men and women have in common?
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function of the transverse perineal muscle?
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to give additional support ot the perineal body
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function of the external urethral sphincer? specific location in men vs women?
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to close off urination voluntarily
men- membranous urethra women- pretty much at the urethral opening |
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what 2 muscles are unique to women?
imagine them. |
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function of the compressor urethrae?
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aids with the external urethral sphincter to close off the urethral by compressing it
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function of the sphincter urethrovaginalis??
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forming a spnicter to help close the vagina and the urethra using the perineal body as an anchor
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can I feel the sphincter urethrovaginalis on myself?
what is it's span? how do I know? |
yes- it is right around where the deep perineal pouch should be.
beyond that, I cannot constrict my vagina |
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what things do men have in the perineal pouch that women dont?
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the bulbourethral/cowper's glands
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