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What does the urtethra pierce when entering the outside world?
- the UG diaphragm: here it is surrounded by urethral sphincter
- Under voluntary control through the somatic nervous system
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WHat divides the greater and lesser pelvis?
The pelvic brim
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what is the pelvic floor formed by?
pelvic floor muscles- diaphragm- LA mm
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What marks the pelvic brim?
top of S1 and the pubic symphesis
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What is on the floor of the pelvis?
- - perineum lies within the flor
- - diamond shaped between the pubic symphesis and coccyx
- - this forms the anal and urogenital triangles
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What are the contents of the lesser pelvis of a female?
- - peritoneal reflections over the UG system- bladder, uterus, vagina, rectum
- - recto- uterine space (space behind vagina and infront of the rectum)
- - uterus on top of the bladder
- - vagina, uterus and ligs can be palpated vis rectum
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What is the broad ligament?
- - two layers of peritoneum sandwiched together outside the uterus
- - round ligament runs through anterior part of broad ligament
- - suspensory ligaments of ovary contains ovarian vessels
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What are the structures that support the uterus?
- - part of the broad ligament
- - round ligament of the uterus
- - - ligaments around the cervix
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What is the position of the uterus normally?
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What are the ligaments around the cervix?
- - cardinal ligament (transverse cervical)- at the base of the broad ligament- contains uterine artery and vein
- - uterosacral ligament- from sacrum to uterus
- - pubocervical- from the side of the cervix to the pubic symphosis
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what are the components of the broad ligament?
- Mesometrium - the mesentery of the uterus; the largest portion of the broad ligament
- Mesosalpinx - the mesentery of the Fallopian tube
- Mesovarium - the mesentery of the ovaries.
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What is the male equivalent of the round ligament of the uterus?
spermatic cord
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Note/ decent of gonads explains termination of round lig in labia majoria
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What is the blood supply of the female pelvis?
- - branches of the internal iliac crest
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What are the three division of the internal iliac artery?
- - gluteal
- - pelvic
- - pudendal
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What artery supplies the ureter?
- uterine artery
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Where does the pudendal artery supply blood to?
- provides blood to the external genitalia
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Where does the gluteal division of the internal iliac artery supply blood to?
- two branches
- Superior and inferior branches:
- - superior- largest branch, supplies glutes, piriformis etc
- - inferior- (sciatic art), buttocks and back thigh
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What does the pelvic arteries supply?
- organs of the pelvis
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Ovarian artery connects with?
uterine artery
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Note/ during perganacy uterine artery pulse can be felt thru the vagina
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What does the ovary artery supply?
- -ovaries
- - ureter (ovary art turns into uterine art)
- - apendix
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Where are the ext nodes of the lymphatic system?
- - sit near the pelvic brim near common and external iliacas
- - they drain lower limb and genitals (superficial and deep)
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What are the two groups of nodes?
- - external nodes
- - internal nodes
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What are the internal nodes and where are they situated?
- drain pelvic floor and viscera
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What lymphatic node does the ovaries drain into?
-para- aortic node near renal arteries
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what lymphatic node do the fundus of uterus drain into?
- para- aortic node
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What lymphnode does the body of uterus drain into?
- generally to internal iliac node, some to superficial inguinal
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what lymphnode does the cervix drain into?
- - internal iliac nodes
- - also deep sacral nodes
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Pelvis inlet and outlet
- Inlet- is the pelvic brim
- outlet- between ischial spine
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Male genital/ UG system
- - peritoneal reflections over male system
- - retropubic space- access to male UG system
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What sphincter is voluntary and involuntary of the bladder?
- - internal urethral sphincter is involuntary- primary mm in control of the exit of urine- smooth mm
- - external urethral sphincteris- located at the bladder's distal inferior end in females and inferior to the prostate in males- skeletal mm- voluntary
- - female ext sphincter not very strong
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Urethra in males
- - longer than female
- - surrounded by lobes of prostate
- - prostate lobes develop as diverticula from prostatic urethra
- - medial lobe (surrounds urethra) prone to BHP (begins at 45 yrs and by age 80- 80% of men have BPH)- hypertrophy
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What are the layers of the perineum?
- - superficial perineal space (three muscles and root of penis)- outside
- - Inferior fascia of UG diaphragm (aka perineal membrane)
- - UG diaphragm- sphincter urethral and transverse perinel mm, bulbourethral glands. Vol sphincter
- - Superior fascia of UG diaphragm
- -Levator ani- three mm- puborectalis, pubococcygeous, iliococygeous
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What mm is responsible for the bend in rectum?
- puborectalis
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Scrotum
- - pouch that develops from ant abdominal wall
- - testis have superior retroperitoneal orgin
- - drags layers with it and these form various coverings (tunics) or spermatic cord and testies
- - vessels, nerves and vas within fascia that surrounds spermatic cord
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WHat is the anatomical position for the penis
- erect
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Anatomy of the penis
- - 3 cylinders of erectile tissue
- - two corpora cavernosum- crus attached to pubic arch
- - corpora spongeosum expands to form glans and transmits urine and ejaculate
- - each cylinder is surrounded by elastic sheath
- - three cylinders invested by deep fascia of penis
- - suspensory and fundiform ligament suspend penis
- - when errect the ANS controls
- - when errect, stays errect by the compression of the vein
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What is the blood supply of the penis?
- - two arteries: dorsal and deep arteries of penis
- - most venous drainage into dorsal vein of penis
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Female genitalia
- - peritoneal reflects over female UG system
- - recto- urterine space
- - uterus bent anteriorly over bladder (antiverted/antiflexed)
- - vaginal fornices- intercourse
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What are the parts of the external female genitalia?
- - located in perineum
- - the vulva
- - labia majora (outer hair)
- - labia minora
- - vestibule or urogenital sinus-between labia minora
- - clitoris
- - urethal orifice
- - vagina
- - has 3 layers of erectile tissue- but one uretral tube in the middle
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Vagina
- - fibromscular tube- from vestible to uterus
- - for elimination of menstrual fluids
- - recieves penis during sexual intercourse and holds sperm
- - forms birth canal for expulsion of fetus
- - fornices (singular fornix)
- - interesting wall- four layers
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What are the four layers of the vagina?
- - epithelium
- - lamina propria
- - fibromuscular
- - adventitial (nerves and skeletal mm)
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What are the layers of perioneum in a female?
- - three mm, root of clitoris, bulb of vestibule, greater vestibular gland
- - inferior fascia of UG diaphragm (perineal membrane)
- - UG diaphragm- sphincter urethral & deep transverse perinel mm
- - Levator ani
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Male and female structures
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WHat supplies most of the peritoneum?
- - pudendal artery
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What nerve innervates the perineum?
- branches of pudendal nerve supplies most. S 2-4
- - micturition
- - defectation
- - erection
- - parturtion
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What is the sexual response mediated by?
- - sexual response mediated by coordinated activity of autonomic and somatic NS in both genders
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WHat are the autonomic effects of the sexual function?
- - vascular dilation- causes penile or clitoral erection (parasympathetic)
- - stimulation of prostatic or vaginal secretions
- - smooth mm contractioon of vas deferns in ejaculation (sympatheitc) and rhythmic vaginal contractions during orgasm
- - contraction of somatic pelvic mm (BS and IC) during orgasm
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WHat are the four nerve pathways of the sexual act?
- - sensory afferents
- - somatic (voluntary) efferents
- - sympthetic and para efferents
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What is sexual function usually driven by?
- - psychic and reflex mechanisms that generate sexual sensations
- - erection- emission- ejaculation- resolution.
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physiology of sexual function
- - reflexs arcs throughthe spinal cord important
- - both motor and sensory nerve fibres involved
- - dual projections from thoracolumbar (T10-L2) and lumbosacral (S2-S4) segments in splanchnic nerves and autonomic plexi
- - sexual responses are mediated by the coordinated activity of somatic (sensory and motor), sympathetic, parasympathetic divisions of the nervous systems (four pathways)
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Somatic afferent branch involved in sexual sensations?
- - glans richly inervated in both genders
- - afferents travel in pundenal nerve (S2,3,4), sacral plexus, sacral cord then up to somatosensory cortex
- - labia, scrotum, and anal perineal region stimulation adds to sexual sensation
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Visceral afferent for sexual sensations
- - sexual sensations also originate in internal structures
- - urethral, bladder, prosate, testes, seminal vesicles and vas deferens
- - inflammation and aphrodisiac drugs can lead to sexual sensation by their action inside the above organs
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