Week 5
The Anal and Urogenital Triangles
**the boundaries for the anal and UG triangles are the same for males and females since they are bony landmarks.
Aneurysm types
2 types Saccular eccentric, involving only a portion of the circumference of the vessel wall. Fusiform concentric, involving full circumference of the vessel wall Causes Atherosclerosis, hypertension, vasculitis, infection (Mycotic), connective tissue disorders, trauma, iatrogenic
"Point and shoot"
(P)oint: Parasympathetic stimulates erection (point) (S)hoot: Sympathetic stimulates ejaculation (shoot)
calices of kidney
Drainage system
Iliacus m.
Insertion: lesser trochanter, psoas tendon Acts with psoas major muscle Stabilizes hip joint Innervation by branches of femoral n.
The male urethra has three parts
Prostatic, Membranous, Spongy
Ligaments of the pelvis
sacrotuberous and sacrospinous
neural crest
A band of cells along the border where the neural tube pinches off from the ectoderm; the cells migrate to various parts of the embryo and form the pigment cells in the skin, bones of the skull, the teeth, the adrenal glands, and parts of the peripheral nervous system.
capsule, cortex, medulla
A: capsule B: cortex Corticosteroids Androgens C: medulla Norepinephrine Epinephrine -Innervated by presynaptic sympathetic fibers
Aberrant right subclavian artery
AKA Arteria Lusoria Incidence of .05-2% Right subclavian is the 4th branch from the aortic arch. 80% posterior to the esophagus 15 % between esophagus and trachea 5% anterior to the trachea Can cause dysphagia Due to compression between the esophagus and vertebrae this may result in stenosis
Seminal colliculus (verumontanum) and utricle
An important anatomic landmark for a congenital (developmental) obstruction of the urethra in newborn male infants.
Right aortic arch with aberrant left subclavian artery
Aortic arch courses to the RIGHT of the trachea Right aortic arch occurs in approximately 0.1% of the population This is the most common right aortic arch variant Branching pattern left common carotid, right common carotid, right subclavian, and left subclavian artery Associated with congenital heart disease 5-10% of the time. When CHD present most common is tetralogy of fallot
sacral plexus
Arises from L4-S4 - Serves the buttock, lower limb, pelvic structures, and perineum
Kidney endocrine functions
Blood Pressure Regulation As blood passes through your kidneys, special cells "measure" blood pressure in the blood vessels leading to your kidneys (renal arteries) and adjust the amount of the hormone renin that they secrete. Renin controls the production of two other hormones, angiotensin and aldosterone. And these hormones control the width of your arteries and how much water and salt is moved out of the body. Both of these affect blood pressure.
Right aortic arch with mirror branching pattern
Branching pattern left brachiocephalic trunk, right common carotid and subclavian arteries Associated with congenital heart disease 98% of the time. 90% will have Tetralogy of Fallot 6% with Truncus Arteriosis 5% with Tricuspid Atresia
False aneurysm/Pseudoaneurysm
Damage to the vessel wall allows blood to leak through the wall but is contained by the adventitia or the surrounding perivascular soft tissues. The damage allows direct communication from the fistula to the vessel lumen. Risk of rupture is higher for a pseudoaneurysm than an aneurysm of comparable size due to poor support of the aneurysm wall.
Scarpa's fascia, Colles' fascia & Dartos fascia form a continuous layer. There is no fatty layer over......
Dartos fascia. Dartos fascia contains smooth muscle.
Dissection types
Debakey Type I: originates in the ascending aorta and propagates at least to the aortic arch Type II: confined to the ascending aorta Type III: originates distal to the subclavian artery in the descending aorta Stanford Classification A: involves the ascending aorta and can propagate to the aortic arch and descending aorta. B: do not involve the ascending aorta
pectinate line of anal canal
Dividing line of Visceral Motor & Sensory, And Somatic Motor & Sensory innervation. Somatic Motor & Sensory innervation is by the Pudendal Nerve. - If you drew a line across the bottom of the anal sinuses
exocrine vs endocrine glands
Endocrine glands are those that release their secretions into the bloodstream. The blood then carries the substances throughout the body until it reaches its target organ. Exocrine glands are those glands that directly release their secretion into the target organ or tissue.
Coverings of Spermatic Cord & Scrotum
External spermatic fascia from External. Oblique m. Cremaster m. & fascia from Internal Oblique m. & fascia Internal spermatic fascia from Transversalis fascia Tunica vaginalis from Abdominal peritoneum
True vs False pelvis
False Pelvis = Greater Pelvis True Pelvis = Lesser Pelvis The false pelvis is part of the abdomen.
Sexual Dimorphism of Pelvis
Female is wider and shorter Heart shaped in male vs oval in female Subpubic angles is much wider on females Subpubic on male is less than 70 degrees
Aneurysm
Focal abnormal dilatation of a blood vessel. Bound by all 3 layers of the vessel wall (intima, media and adventitia). Risk of rupture proportional to the size of the aneurysm
fat in renal sinus
Gives the kidney buoyancy
Greater pelvis vs lesser pelvis
Greater pelvis (false pelvis) - located superiorly, it provides support of the lower abdominal viscera (such as a ileum and sigmoid colon). It has little obstetric relevance. Lesser pelvis (true pelvis) - located inferiorly. Within the lesser pelvis reside the pelvic cavity and pelvic viscera.
Intramural Hematoma
Hemorrhage into the wall of the aorta from the vasa vasorum without an intimal tear. Risk factor: Elderly Hypertensive Blunt chest trauma Penetrating atherosclerotic ulcer
Os coxa is formed by three bones
Ilium Ischium Pubis Fusion occurs 16th-18th yrs Transfer of weight from trunk to lower extremities.
Peritoneal coverings of the rectum
Inferior 1/3 = Subperitoneal Middle 1/3 = Anterior surface Superior 1/3 = Ant. & Lat. Surface Then forms sigmoid mesocolon
Dissection
Intima shears apart from the media and blood dissects the layers apart, painful and acute, related to high blood pressure or a weakened aortic wall (Marfan's, Ehlers-Danlos) Risk factors -Hypertension -bicuspid aortic valve -aortic coarctation -abnormal connective tissues (Marfan syndrome, Ehlers-Danlos syndrome) -Turner syndrome -pregnancy -intra-aortic balloon pumps -ciprofloxacin
Sites of Constriction of Ureter
Junction with renal pelvis At brim of pelvis inlet At wall of urinary bladder Note: Ureter is crossed by uterine/testicular a.
If there is an abdominal aneurysm, the _______ can become entrapped by the ______.
Left renal vein SMA
Varicosities occur in the testicular or ovarian vein if......
Left renal vein is compressed - can also cause vomiting because of duodenum compression
An artery, vein & nerve leave the Pelvis via the Greater Sciatic Foramen and enter the Perineum via the......
Lesser Sciatic Foramen.
Variant Arch Anatomy
Most common variant of the aortic arch. Seen in approximately 15% of the population. Shared origin of the brachiocephalic trunk with the left common carotid artery. Commonly referred to as a bovine aortic arch. Is routinely asymptomatic, but may affect surgery/angiography
seminal fluid (semen)
Most of the fluid in semen is made up of secretions from male reproductive organs. Semen contains citric acid, free amino acids, fructose, enzymes, phosphorylcholine, prostaglandin, potassium, and zinc. 46 to 80 percent of the fluid is produced by the seminal vesicles 13 to 33 percent by the prostate gland 5 percent from the testicles and epididymis 2-5 percent from Bulbourethral and urethral glands Seminole fluid gives sperm energy
coarctation of the aorta
Narrowing of the thoracic aorta lumen. Congenital More frequent in males with a 2-3:1 ratio Can be split into 2 subsets Infantile Adult
Kidneys in Situ
Note: Kidneys Suprarenal Glands Nerves Supply-The renal plexus is located around the renal artery and contains postganglionic fibers from the sympathetic nervous system (T10 to L2). The nerve fibers from the plexus enter the kidney with the branches of the renal artery and regulate the vascular tone and the secretion of renin. Abdominal Aorta Inferior Vena Cava
Contact area of right kidney
Note: Liver Duodenum Colon
Contact areas of left kidney
Note: Stomach Tail of pancreas Spleen Descending colon
Labeled diagram of the uterus
Note: The vaginal fornices surround the vaginal portion of the uterine cervix. The cervix enters the anterior vaginal wall. The ovary has tubal and uterine extremities.
bones of pelvic girdle
Pelvic girdle contains genitals and GI tract
Perirenal vs Pararenal fat
Perirenal Inside renal fascia Pararenal Around (outside) renal fascia Fat
Suprarenal gland sits within the.......
Perirenal fat
Pelvic inlet boundaries
Posterior - sacral promontory (the superior portion of the sacrum) and sacral wings (ala). Lateral - arcuate line on the inner surface of the ilium, and the pectineal line on the superior pubic ramus. Anterior - pubic symphysis.
Common femoral artery pseudoaneurysm
Predominantly occurs after endovascular procedure from arterial access. If amenable treated with direct thrombin injection. Rarely requires open repair.
Muscles of the Posterior Abdominal Wall
Psoas major m. (pso'as, Gr. muscle of the groin) Psoas minor m. (absence level is about 40%) Iliacus m. (ili'acus) Quadratus lumborum m.
Note: There is NO Internal ___________ Nerve
Pudendal
Right Suprarenal gl. _____________ shaped Left Suprarenal gl. _________________ shaped
Pyramidal Semilunar
Suprarenal Veins (Right and Left)
Right suprarenal vein drains directly into the IVC Left suprarenal vein and left inferior phrenic vein join and drain into the left renal vein, which drains into the IVC
The rectosigmoid junction is at the.....
S3 vertebra.
coccygeal plexus
S4, S5, and Co1
Neural Crest Derivatives
Spinal dorsal root ganglia (DRG) Sympathetic chain ganglia Preaortic ganglia GI parasympathetic ganglia Adrenal medulla chromaffin cells
Nerves of the Posterior Abdominal Wall
Subcostal n. (T12 anterior primary ramus) Lumbar plexus (L1-L4 anterior primary rami) 1. Iliohypogastric n. 2. Ilioinguinal n. 3. Genitofemoral n. 4. Lateral femoral cutaneous n. 5. Obturator n. 6. Accessory obturator n. (present in only 9% of the time, It crosses over the superior pubic ramus) 7. Femoral n. Lumbosacral trunk (L4 and L5) -joins the sacral plexus
Abdominal Aorta Levels
T12 — L4
The kidneys span vertebral levels....
T12-L3 Note: Right kidney is more inferior
Inf. Vena Cava Levels
T8 — L5 No Valves in Abdomen Note ascending lumbar and right inferior suprarenal
A corpus cavernosum penis is one of a pair of sponge-like regions of erectile tissue, which contain most of the blood in the penis during an erection. Such a corpus is homologous to what in a female?
The corpus cavernosum clitoridis in the female; the body of the clitoris that contains erectile tissue in a pair of corpora cavernosa with a recognizably similar structure.
Course of Ductus Deferens
The ductus deferens exits the deep inguinal ring lateral to the inferior epigastic vessels. It courses superior to the ureters and approaches the prostate medial to the seminal vesicles.
Veins of the Rectum & Anal Canal
The internal rectal plexus is mainly formed by superior rectal vv.; the external rectal plexus by inferior rectal vv. The internal and external rectal plexi give rise to internal and external hemorrhoids, respectively.
kidney exocrine function
The kidney is traditionally regarded as an exocrine gland, producing urine to regulate body fluid volumes and composition and to excrete nitrogenous wastes.
Longer renal vein
The left vein is longer than the right vein because the inferior vena cava lies closer to the right kidney.
Boundries of Perineum
The perineum is the region between the thighs inferior to the pelvic diaphragm. The boundaries of this region are the same as that for the pelvic outlet, namely the pubic symphysis, ischiopubic rami, sacrotuberous ligaments, and coccyx.
Rupture of Spongy Urethra
The rupture is usually due to a straddle injury or incorrect catheterization.
Three pair of muscles & three erectile bodies are in the superficial perineal space.
The structures located in the superficial perineal pouch are: 3 paired muscles (the superficial transverse perineal, bulbospongiosus, and ischiocavernosus), the crura of the penis and the bulb of the penis as well as the vessels and nerves that serve these structures.
Cross section of penis
The two corpora cavernosa and corpus spongiosum are three expandable erectile tissues along the length of the penis, which fill with blood during penile erection. The two corpora cavernosa lie along the penis shaft, from the pubic bones to the head of the penis, where they join. These formations are made of a sponge-like tissue. The male anatomy has no vestibular bulbs, but instead a corpus spongiosum, a smaller region along the bottom of the penis, which contains the urethra and forms the glans penis.
Arteries of the Ureters
The ureters receive arterial ureteric branches from: renal artery aorta ovarian/testicular artery common iliac artery inferior vesical artery superior vesical artery
chronic renal dialysis cysts
These adult kidneys are about normal in size but have a few scattered small cysts, none of which is over 2 cm in size. This is cystic change associated with chronic renal dialysis.
penetrating atherosclerotic ulcer
Ulcerating atherosclerotic lesion that penetrates the intima and progresses into the media leading to a hematoma of variable size within the media. Can lead to aortic dissection, saccular aneurysm or even rupture. Risk factor: Hypertension Smoking Coronary artery disease COPD Male sex
Double aortic arch
Vascular ring from the splitting of the ascending aorta into two limbs that pass to either side of the trachea and esophagus. Types right dominant arch - ~70% co-dominant arch - ~5% Left dominant arch - ~25% Presentation: Children frequently present with difficulty breathing. Adults present with difficulty swallowing
The internal pudendal a. gives rise to.....
a perineal a., that enters the superficial perineal space. The continuation of the internal pudendal a. enters the deep perineal space. The perineal a. does not supply blood to erectile tissue.
The rectum has to go through the pelvic diaphragm, this helps form the.....
anorectal flexure (ca. 80 degrees), before becoming the anal canal.
Normal position of the uterus
anterflexed and anteverted
The renal vein is _________ in relation to the renal artery
anterior
The female urethra is intimately associated with the....
anterior wall of the vagina.
Pelvic outlet boundaries
anteriorly: the pubic arch. laterally: the ischial tuberosities. posterolaterally: sacrotuberous ligament. posteriorly: coccyx.
Simple renal cysts
can also be multiple, but they are never as numerous as with polycystic change, and they do not predispose to chronic renal failure. Such simple cysts become more common as persons become older.
Testicular torsion is a serious condition. The testicular blood supply is.....
compromised. As the spermatic cord twists the epididymus assumes an anterior position in the scrotum vs. being in the normal posterior
The pampiniform plexus acts as a......
counter current heat-exchange mechanism cooling testicular arterial blood. An engorgement of this plexus is called a varicocele.
The levator ani m. (part of pelvic diaphragm) blends into the.....
deep external anal sphincter.
Coarctation Infantile
diffuse hypoplasia or narrowing of the aorta from just distal to the brachiocephalic artery to the level of ductus arteriosus discrete area of constriction just proximal to the ductus but distal to the origin of the left subclavian artery blood supply to the descending aorta is via the patent ductus arteriosus
The deep inguinal lymph nodes primarily drain the......
glands of the clitoris and penis, receiving lymph also from the superficial inguinal nodes.
Lesser trochanter of femur is the insertion of......
iliopsoas m.
Frequently there is an "aberrant" obturator a. arising from the...
inferior epigastric a.
The external anal sphincter is skeletal m. innervated by.....
inferior rectal nn.
Caution: the female pelvis does NOT have an.....
inferior vesical a. It is replaced by the vaginal a.
medulla of kidney
inner portion of kidney, composed of collecting tubules that empty into the renal pelvis
The lymphatics of the inferior rectum above the pectinate line drain into the......
internal iliac nodes.
Ant. Sup. Iliac spine is near path of......
lat. femoral cutaneous n.
Iliacus muscles has the ______________ nerve crossing it
lateral cutaneous femoral
Renal artery on _____ is shorter
left
The external iliac nodes primarily drain.....
lower limb, pelvic, and deep peritoneal structures.
Lymphatic drainage of the testis
lymphatics from the scrotum drain to the superficial inguinal lymph nodes. Inflammation of the scrotum may cause tender, enlarged superficial inguinal lymph nodes. In contrast, lymphatics from the testis follow the testicular vessels through he inguinal canal and into the abdominal cavity, where they drain into lumbar (lateral aortic) and preaortic lymph nodes. Testicular tumors may metastasize to lumbar and preaortic lymph nodes, not to superficial inguinal lymph nodes.
The obturator a. will supply mm. in the....
medial compartment of the thigh.
Broad ligaments of the uterus
mesosalpinx mesovarium mesometrium
The superior aspect of the rectum is drained by the.....
middle rectal nodes, lymph from which eventually flows into the lumbar nodes
Rectum = straight. Named from animal dissections, the human rectum is......
not straight, but bends right & then left before ending in the anal canal.
Angle that kidneys sit at
obliquely - they are NOT sitting flatly as pictures often suggest
Obturator artery is in the....
obturator canal, which is also traversed by obturator n.
The Pudendal Canal is found within the fascia of the......
obturator internus m.
Hypospadius is a common defect (3-5/1,000 males) where the urethra.....
opens on the ventral side of the penis.
Meckel's diverticulum is an.....
outpouching or bulge in the lower part of the small intestine. The bulge is congenital (present at birth) and is a leftover of the umbilical cord. Meckel's diverticulum is the most common congenital defect of the gastrointestinal tract.
The abdominal cavity is continuous with the _____________________
pelvic cavity It is called the abdomino-pelvic cavity
The obturator internus m. can be seen in the.....
pelvis & the perineum.
The pelvic diaphragm separates.....
pelvis from perineum.
The internal pudendal a. arises in the......
pelvis, briefly enters the gluteal region (posterior to ischial spine) and enters the perineum within the pudendal canal. The internal pudendal a. will supply blood to the both anal and urogenital triangles.
Prostatic cancer can metastasize into the....
prostatic venous plexus and spread to the brain via the internal vertebral plexus and its communication with the dural venous sinuses.
Intrarenal arteries
segmental, interlobar, arcuate, interlobular
Coarctation adult
short segment abrupt stenosis of the post-ductal aorta due to thickening of the aortic media and typically occurs just distal to the ligamentum arteriosum
The external anal sphincter is.....
skeletal m. innervated by inferior rectal nn.
The internal anal sphincter is.....
smooth m. innervated by both divisions of the ANS.
Below the pectinate line, lymphatics of the anal canal will primarily drain into the.....
superficial inguinal (horizontal) nodes.
The internal anal sphincter is smooth m. innervated by.....
the ANS.
Ascending lumbar veins are tributaries to....
the Azygos System
The levator ani portion of the pelvic diaphragm blends into.....
the deep external anal sphincter.
The apex of the prostate lies just superior to......
the deep perineal space. Note the external urethral sphincter surrounding the anterior aspect of the prostate.
The superior gluteal a. normally leaves the pelvis by passing between....
the lumbosacral trunk (L4,5) and S1 ventral primary ramus.
McBurney's point
the name given to the point over the right side of the abdomen that is one-third of the distance from the anterior superior iliac spine to the umbilicus (navel). This point roughly corresponds to the most common location of the base of the appendix where it is attached to the cecum.
In general, lymphatic vessels course retrogradely along.....
the visceral arteries.
Internal hemorrhoids are usually not painful unless.....
they prolapse and strangulate and/or ulcerate. External hemorrhoids are painful, especially if thrombosed.
The peritoneum, in either sex, sweeps off the abdomen and enters the.....
true pelvis. It NEVER touches the pelvic diaphragm.
The urogenital hiatus of the female pelvic diaphragm includes the.....
urethra & vagina.
Nephrons in cortex of kidney produce...
urine
In females, peritoneum covers part of the uterus, & all of the.....
uterine tubes, uterine ligaments & ovaries (the adnexa). On the ovaries it is erroneously called "germinal epithelium".
psoas major (innervation, action, location)
vertebral bodies Transverse processes Intervertebral discs T12-L4 Insertion: lesser trochanter Flexes thigh (with iliacus m.) When sitting: flexes trunk Flexes vertebral column laterally Balances trunk Innervation by L2-L4 ventral rami
