Connective tissue layer that holds the kindey in place … □
Attaches to the liver which attaches to the diaphragm □
Renal fascia
I think this is inside the fascia but outside the capsule
Surrounds the kidney □
Keeps a cushion on the kidney □
Perirenal fat
Outside the kidney □
Keeps the pressure □ Renal Capsule Liver □ Respiratory Diaphragm □ Close by ○
Stuff comes in and out □ Renal hilum On top □ Renal Cortex Renal column □
At the end of each pyramid is a renal papilla
All of the collecting ducts of a nephron → … all funnel down → papilla which is a collection of holes → minor calyxes → major calyxes → renal pelvis → ureter → bladder
Renal pyramid □ Renal Medulla ○ Uretoropelvic junction □
Ureter has to go over psoas and iliacs … it's like a bridge
Psoas muscle □
Where ureter goes into the bladder Uretrovesicular junction □ See below Extrasegmental artery □
Places where stone gets stuck:
Grind along the ureter which makes it hurt □
These fragments are from a calcium kidney stone (calculus) that was broken up by lithotripsy (high energy sounds waves) before removal.
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Kidney stone fragment ○ Urogenital Anatomy •
Urogenital Anatomy
Tuesday, March 26, 2013 1:30 PMCan have more than one artery to the kidney … this is another place the stone can get stuck as the artery kinks the ureter □
Note: Extra segmental artery
Hydronephrosis = water in the kidney □
Sometimes the kidney will droop (ptosis) which will kink the ureter and cause an increase in fluid in the ureter which is called hydroureter. Anything that blocks the flow will back up fluid and can cause hydronephrosis.
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The muscle layers will produce waves of peristalsis to push urine to the bladder. The epithelial layer is a mucosa or mucous membrane (that is that it has mucus-producing cells) and it is transitional epithelium that can expand greatly with increased volume. The inner muscular layer is longitudinal while the outer layer is circular. This the opposite order of muscle from the GI tract which is confusing.
○ + ureteral opening Ureter □
Lines everything in the abdomen
Peritoneum □
Detrusor muscle □
Smooth area in the bladder between the ureteral opening and the urethral opening
Trigone □
No internal sphincter in females
External urethral sphincter □
Holds contents of that part of the pelvis in
Note: pelvic diaphragm doesn’t hold the whole abdomen in … pelvis is tilted forwards and the pubic symphsis is pointing downwards and therefore all the weight is concentrated on that (as well as the abdominal muscles)
Deep muscles of perineum □
What are these ◊
What connects the two is the levator ani
Inferior + Superior pubic ramus of hip bone □ Is short in females Urethra □ Structures ○
In between the bladder and erectile tissue of the penis □
Has prostatic urethra □ Prostate Prostatic urethra Membreanous urethra
Penline (spongy) urethra
Sections □
Produces mucous and alkaline substance
Lines penile urethra with mucous so when there is sprem in there it doesn’t get activated in the urethra Bulbourethral gland □ Urethra ○
Produce most of the fluid that ends up on the semen □
Seminal vesicles
Goes to testicle (catching sperm) □
Goes over top ureter and mixes together □
Vas deferens
Vas and seminal vesicles join together □
Based on the wiki screenshot above it’s the urethra (prostatic urethra to be specific)
Does it secrete into urethra or prostate? □
Ejaculatory duct
This is so that the urine and semen doesn’t mix □
Internal urethral sphincter
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Male ○
Male Pubic symphysis Urinary bladder Colon Rectum Prostate Root of penis
Completely surrounds urethra all the way □
Corpus spongiosum
Two tubes of this □
Erectile tissue □
Corpus cavernosum
Head of the penis □
Glas penis
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The erectile tissue is not as apparent in the female as the male. It’s not as if there is nothing in the female pelvis and thus it is a bit hard to imagine a baby’s head coming through. Notice that this uterus is anteverted (i.e., leaning forward) and retroflexed (i.e., bent backward). Normally the uterus would be both anteverted (leaning forward) and anteflexed (flexed forward). Because of the version of the uterus, it is almost horizontal in the nonpregnant state.
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Female
Homologous to the corpus cavernosum in males □
Clitoris
Layer of fat in front of the pubis symphsis □
Mons pubic
Don’t confuse with uterus □
Urinary bladder
On top of the urinary bladder □
Could also be retroverted and retro-flexed … but you want anti, anti
Is leaning forward (anti-verted) … and its bent so its anti-flexed □
Part of the uterus □
From this is the vagina? □
External Os of the Cervix □
Uterus
Uterine tube
Catches the egg (when there is ovulation) □
Note that the the fimbriae of the infundibulum of the uterine tube are tight to the ovary at ovulation (lets the egg go into the fallopian tube (the infundibulum) from the ovary)
□ Fibriae Ovary Mucosal layer □
Mucous connective tissue □
Labium Minus
Also has hair on it □
Stratified squamous epithelium □
Completely different from labium minus □
Labium majus
Peritoneum goes to here … this is I think between the bladder and the uterus □
Vesicouterine pouch
Also called retrouterine cul-de-sac □
Pouch of Douglas
Also called retrouterine cul-de-sac □
This is the lowest place in the abdominal cavity … so mucous from infection can gather here □
Should have rugae in it … □ Vaginal lumen Holds everything in □ Bony pelvis
Ilium, ischium and pubis are three separate bones that grow together ○ Sacroiliac □ Sacrococcygeal □ Pubic symphsis □
In the last 3 months of gestation all of these joints relax remarkably. □
Note □ Joints
Movement of the SI joint, when the women is in the dorsal lithotomy position (bottom right of the picture), may increase pelvic diameter 1.5-2.0 cm.
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That being said, you don’t want to give birth like this cause baby would block the mom's IVC □
Birth ○
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Light and thin Heavy and thick
Shallow false pelvis Deep, cup shaped false pelvis
Large, slightly oval pelvic brim Small, heart-shaped pelvic brim Base of the red triangle is long
Pubic arch greater than 90 degrees
Base of the red triangle is shorter Pubic arch less than 90 degrees Coccyx angled towards the anterior
Cups the pelvic contents
Coccyx angled strongly towards the anterior Widest point of the pelvic hole thing (when
you try to make a horizontal line) is right in the middle
Widest point is closer to the posterior
This is the size of a baby's head □
>10 cm □
Distance between the sacral promontory and the pubic symphsisis □ Anterioposterior diameter Also has to be >10 cm □ Transverse diameter ○
Babies have small heads and females have large pelvic outlets … easy to give birth □
Monkeys
Decided to walk upright … smaller pelvic hole □
Also became smarter so had bigger heads □
Ausrilopicathus
It is generally assumed that there are two great drivers of change in the female human pelvis- the first is the adoption of an upright posture to accommodate a bipedal gait. That narrow the pelvic outlet and inlet because there was more pressure on the pelvic diaphragm. while the second is the development of a fetus with a large cranium (smarter_. As can be seen here, the chimpanzee which is neither bipedal nor has a fetus with a large cranium offers few problems for the pelvis. The australopithecines had a wide ilium but narrow pelvis adapted for a bipedal gait which forced the fetal head into a lateral position. The large head of the human fetus adds a further complication and the human fetus normally ends up filling the pelvis in a occiput-anterior position. And that is how we ended up with such a peculiar pelvis
□ Full explanation
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There are additional ligaments which are not obvious until the broad ligament and peritoneum is removed. These include the uterosacral ligament and the suspensory ligament of the ovary.
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Is the top of the uterus □
Uterine fundus
Is not a ligament □
It is a neurovascular bundle … doesn’t hold the ovary up □
Suspensory ligament of the ovary
Connects the uterus and the ovary □
Utero-ovarian ligament
Joining the uterine fundus forwards … keeps it from moving around □
Round ligament
Holds the uterus back to the sacrum □
Utero-sacral ligament
Goes all over the sides of the uterus and fallopian topes and ovaries … holds it to the sides □ Broad ligament Note ○
Without estrogen these get loose □
Note
Notice that everything is covered with peritoneum… everything! No exceptions. The peritoneum provides some support particular ly since it folds over the sides of the uterus and tubes to make a double thick layer of parietal peritoneum which is called the broad ligament.
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Use a pessery to stop it from coming out (bottom left picture) □
Can also use colposususpension □ Prolapsed uterus Prolapse vs. inversion ○
All of the primary sexual characteristics (the internal and external organs of reproduction) develop from same starting point in males and females.
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All of these organs have homologs in both sexes. □
Embryological
In the case study we will talk about how all these homologous structures develop from the indifferent stage of embryology □
Ovary is like the testes □
Crus of the clitorus is like the corpus cavernosum □
Glans of penis is like glans of clitoris □
Round ligament is homologus to the gubernaculum □
Labia majora fuse in males to become to become the scrotum □
Development
Homologs ○
25:12 •
Sperm to egg □
Old fashioned fertilization
Put the nucleus of the sperm right inside the egg □ In vitro fertilization Introduction ○ Makin’ eggs
At birth there are about 2 million of these primary oocytes hanging about in the ovary □
23+23+23 ◊
They cannot be fertilized unless you wanted a triploid fetus (i.e., 69 chromosomes)
These primary oocytes are diploid (i.e., they have a full set of 46 chromosomes) □
At the onset of puberty (about 11 or so) there are about 300,000 primary oocytes and by the time of the menopause there will essentially no primary oocytes left in the ovary
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The process of oogenesis begins in the fetal ovaries where stem cells (called oogonia) produce primary oocytes
If a woman runs out of eggs early then menopause starts early
Only about 500 eggs could ever be released if you never became pregnant and always ovulated with every menstrual cycle
They are unchanged from the way they were produced in the fetus
The primary oocytes are held in prophase of meiosis I □
A number of primary oocytes restart meiosis 1 early in the menstrual cycle and a few become secondary oocytes.
Fertility drugs such as clomiphene can lead to superovulation which means a number of eggs will go to the secondary oocyte stage and then be ovulated
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This cohort of eggs develop at the same time however only one of these secondary oocytes will be released from the ovary at o vulation
With every menstrual cycle, a few of the primary oocytes wake up □
The completion of meiosis II begins exactly at the time when the sperm contacts the egg (fertilization) □
Is where the egg and surrounding cells (the follicle) develop up to the point of ovulation ◊
Follicular phase
Is where the leftover bits of the follicle hang around and secrete hormones (particularly progesterone) to prepare the lining of the uterus (the endometrium) for a fertilized egg
◊ Luteal phase
The development of eggs in every cycle is called the ovarian cycle and there are two phases to the cycle □
Steps?
Secondary follicle develops … Really only one wins
Follicular Phase □
Make the corpus luteum … which is to rescue the system
Luteal □
Primordial to Primary Follicle □
Follicular Phase
Oogenesis ○
Part #1: Gamete to Fertilization •