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Home , Anal triangle, Appendix of testis, Body of penis, Bulbourethral gland, Glossoepiglottic folds, Hypogastrium

MVDr. Natália Hvizdošová, PhD. MUDr. Zuzana Kováčová

ABDOMEN

Borders outer: xiphoid process, costal arch, Th12 iliac crest, anterior superior iliac spine (ASIS), inguinal lig., mons internal: diaphragm (on the right side extends to the 4th intercostal space, on the left side extends to the 5th intercostal space) plane through terminal line

Abdominal regions  superior - (regions: epigastric, hypochondriac left and right)  middle - mesogastrium (regions: umbilical, lateral left and right)  inferior - (regions: pubic, inguinal left and right)

ABDOMINAL WALL

Orientation lines  xiphisternal line – Th8  subcostal line – L3  bispinal line (transtubercular) – L5

Clinically important lines  transpyloric line – L1 (, duodenal bulb, fundus of gallbladder, superior mesenteric a., cisterna chyli, hilum of kidney, lower border of spinal cord)  transumbilical line – L4

Bones (5):  body  vertebral arch – lamina of arch, pedicle of arch, superior and inferior vertebral notch – intervertebral foramen  vertebral foramen  spinous process  superior articular process – mammillary process  inferior articular process  costal process – accessory process

Sacrum  base of – promontory, superior articular process  lateral part – wing, auricular surface, sacral tuberosity  pelvic surface – transverse lines (ridges), anterior sacral foramina  dorsal surface – median, intermediate, lateral sacral crest, posterior sacral foramina, sacral horn, sacral canal, sacral hiatus  apex of the sacrum

Coccyx  coccygeal horn

Layers of the

1. SKIN

2. + SUPERFICIAL + SUPRAFASCIAL STRUCTURES

Superficial fascias:  Camper´s (fatty layer) – downward becomes m.  Scarpa´s fascia (membranous layer) – downward becomes superficial perineal fascia of Colles´)

dartos m. + Colles´ fascia = tunica dartos

Suprafascial structures: and :  cutaneous brr. of posterior intercostal a. and v., and musculophrenic a. and v.  superficial epigastric a. and v.  superficial circumflex iliac a. and v.  thoracoepigastric v. – abdominal subcutaneous v. – paraumbilical vv.

Lymph:  axillary and inguinal nll.

Nerves:  lateral and anterior cutaneous branches of intercostal nn. (Th7-Th11)  subcostal n. (Th12)  iliohypogastric n. (L1 – lumbar plexus)  ilioinguinal (L1 – lumbar plexus): enters through superficial inguinal ring

3. DEEP FASCIA – FASCIA OF EXTERNAL OBLIQUE ABDOMINIS M. gets on:  scrotum as an external spermatic fascia  thigh as a fascia lata

4. MUSCLES OF THE ABDOMINAL WALL ventral group:  rectus abdominis m. – tendinous intersections, (anterior layer, posterior layer) – arcuate line (Douglas),  pyramidalis m. anterolateral group:  external oblique abdominal m. – inguinal lig. (lacunar lig. – pectineal lig., reflex lig.) – superficial inguinal ring: medial and lateral crus, intercrural fibers  internal oblique abdominal m.  transversus abdominis m. – semilunar line – deep inguinal ring: interfoveolar lig., inguinal falx () dorsal group:  quadratus lumborum m.  psoas major and minor m. 5.

6. PARIETAL - internal surface of anterior abdominal wall - five peritoneal folds which extend toward the umbilicus:

 median umbilical fold – obliterated urachus  medial umbilical fold (paired) – obliterated umbilical a. – superficial inguinal ring  (paired) – inferior epigastric vessels – deep inguinal ring

Arteries of the abdominal wall  posterior intercostal aa. – lateral cutaneous brr.  superior epigastric a. (origin: internal thoracic a.) – anterior cutaneous brr.  inferior epigastric a. – anterior cutaneous brr.  superficial epigastric a.  deep circumflex iliac a.  superficial circumflex iliac a.

Veins of the abdominal wall  thoracoepigastric v.  abdominal subcutaneous vv.  posterior intercostal vv. – lateral cutaneous brr.  superficial epigastric v.  superficial circumflex iliac v.  deep circumflex iliac v.  superior epigastric v. – anterior cutaneous brr.  inferior epigastric v. – anterior cutaneous brr.

Nerves of the abdominal wall  intercostal nn. (Th7-Th11) – lateral cutaneous brr., anterior cutaneous brr., muscular brr.  subcostal n. (Th11)  iliohypogastric n. (L1) – lumbar plexus  ilioinguinal n. (L1) – lumbar plexus

INGUINAL CANAL entrance: deep inguinal ring (lateral inguinal fossa) – medial and lateral crus, intercrural fibers exit: superficial inguinal ring (medial inguinal fossa) – interfoveolar lig., inguinal falx (conjoint tendon)

Walls of the : anterior: aponeurosis of external oblique abdominal m. superior: fibers of internal oblique abdominal m. and transversus abdominal m. inferior: inguinal lig. posterior: transversalis fascia (interfoveolar lig., inguinal falx)

Content: ♂ , cremasteric a., ilioinguinal n., genital br. of genitofemoral n. ♀ round of the , of round lig., ilioinguinal n., genital br. of genitofemoral n.

DIGESTIVE SYSTEM

Oral cavity Vestibul of  upper – nasolabial sulcus, , tubercle of upper lip, frenulum of upper lip  superior fornix of vestibule  lower lip – mentolabial sulcus, frenulum of lower lip  inferior fornix of vestibule  rima oris (oral fissure), commissure of (angle of mouth), parotid papilla (opening of parotid at the level of 2nd upper molar)

Proper oral cavity  gingiva (gum) 

Teeth  superior and inferior dental arches  tooth (dens, odontos) – dental crown (enamel), dental (cement), dental root (cement, apex radicis dentis), pulp cavity, dental pulp . incisors . canines . premolars . molars

Tongue  root of – lingual tonsil, median and lateral glossoepiglottic folds, epiglottic valleculae  body of tongue – median sulcus, terminal sulcus, foramen , vallate papillae, fungiform papillae, filiform papillae, lingual aponeurosis,  apex of tongue  margin of tongue – foliate papillae  inferior surface of tongue – fimbriated fold, , sublingual caruncula, sublingual fold

Muscles of tongue: . extrinsic – m., m., palatoglossus m., m. . intrinsic – superior and inferior longitudinal mm., transverse muscle of tongue, horizontal muscle of tongue

Palate  hard – transverse palatine folds (rugae palatinae), , , palatine  solf palate – uvula, tensor veli palatini m., m., palatoglossus m., palatopharyngeus m., uvulae m.

Salivary glands  minor salivary gll. – labial gll., buccal gll., lingual gll. (anterior lingual gl.), palatine gll., molar gll.

 major salivary gll. . parotid gl. ( on parotid papilla) . sublingual gl. (minor sublingual duct, major sublingual duct on sublingual caruncula) . submandibular gl. ( on sublingual caruncula)

Oropharyngeal isthmus () . uvula . – triangular fold . . semilunar fold . tonsilar fossa – . supratonsillar fossa

Pharynx  nasal part (nasopharynx) – external base of to C2  oral part (oropharynx) – C2-C4  laryngeal part (laryngopharynx) – C4-C6, aditus laryngis (laryngeal inlet), piriform recess, plica nervi laryngei (laryngeal fold)

Pharyngeal muscle Constrictors  superior pharyngeal constrictor m. – pterygopharyngeal part, buccopharyngeal part, mylopharyngeal part, glossopharyngeal part  middle pharyngeal constrictor – chondropharyngeal part, ceratopharyngeal part  inferior pharyngeal constrictor – thyropharyngeal part, cricopharyngeal part 

Levatores  stylopharyngeus m.  salpingopharyngeus m.  palatopharyngeus m. ,

Esophagus  cervical part – C6-Th2  thoracic part – Th2-Th10  abdominal part – Th10-Th11 pharyngooesophageal, bronchoaortic, diaphragmatic constriction

Blood supply and innervation: Arteries: inferior thyroid a. (thyrocervical trunk), posterior intercostal aa., esophageal brr. (thoracic aorta), left gastric a. Veins: esophageal vv., inferior thyroid v., azygos v., hemoazygos v. ( SVC), gastric vv. ( portal v.) : deep cervical nll., tracheobronchial nll., posterior mediastinal nll., left gastric lnn. Nerves: parasympathetic – vagus n., sympathetic – sympathetic trunk

Stomach (ventriculus, gaster)  anterior wall – hepatic, diaphragmatic, free surfaces  posterior wall – splenic, renal, suprarenal, pancreatic, colic, mesocolic surfaces

 cardiac part (cardia) – cardiac orifice, cardiac notch  fundus of – fornix of stomach  body of stomach – gastric canal, , greater curvature, lesser curvature – angular notch  pyloric part – pyloric antrum, pyloric canal, pyloric orifice – sphincter pylori m.

Blood supply and innervation: Arteries: right and left gastric a., right and left gastroepiploic a., short gastric aa. Veins: right and left gastric v., right and left gastroepiploic v., short gastric vv. Lymph: right and left gastric lnn., right and left gastroepiploic lnn., coeliac lnn., splenic lnn., intestinal trunk Nerves: parasympathetic – vagus n. (anterior and posterior vagal trunk), sympathetic – sympathetic trunk (greater and lesser splanchnic n.)

Small intestine – , . superior part (L1) – ampulla (bulb) of duodenum, superior duodenal flexure, intraperitoneally . descending part (L1-L3) – longitudinal fold of duodenum, (Vater`s) – opens bile duct and pancreatic duct, (Santorini`s) – opens accessory pancreatic duct, inferior duodenal flexure, retroperitoneally . horizontal part (L1-L3) – retroperitoneally . ascending part (L3-L2) –

/

Blood supply and innervation: Arteries: superior mesenteric a. – jejunal and ileal aa. – straight aa. Veins: superior mesenteric v. Lymph: superior mesenteric nll., solitary lymphatic nodules (jejunum), aggregated lymphatic nodules (ileum) Nerves: parasympathetic – vagus n., symphatetic – sympathetic trunk

Large intestine  semilunar folds, haustra of colon, omental (epiploic) appendices, tenia coli – free, mesocolic, omental

 Caecum . ileocecal orifice – ileal (ileocecal) valve, superior and inferior lip, frenulum of . vermiform – orifice of vermiform appendix, mesoappendix

– from right iliac fossa to right 10./11. rib – right (hepatic) colic flexure

– from right 10./11. rib to left 8. rib – left (splenic) colic flexure, transverse mesocolon

– from left colic flexure to left iliac crest

– from left iliac crest to S2 – S3, sigmoid mesocolon

Blood supply and innervation: Arteries: superior mesenteric a. (ascending and transverse colon), inferior mesenteric a. (descending and sigmoid colon) Veins: portal v. Lymph: superior and inferior mesenteric lnn.  coeliac lnn. Nerves: parasymphatic – vagus n. (ascending and transverse colon), pelvic splanchnic nn. (descending and sigmoid colon) sympathetic – sympathetic trunk

Rectum  sacral flexure, perineal flexure, lateral flexures  rectal ampulla – transverse rectal folds – superior, middle (Kohlrausch`s), inferior  – , , , anorectal line, internal and m.

Blood supply: Arteries: inferior rectal a. Veins: inferior rectal vv.  internal pudendal vv.. Lymph: internal iliac lnn.

Liver  right and left lobe  quadrate lobe  caudate lobe – papillary process, caudate process

 diaphragmatic surface – cardiac impression, bare area, falciform lig., right coronary lig. – right trianguar lig., left coronary lig. – left triangular lig. – fibrous appendix

 inferior margin

 visceral surface – fissure for round lig., fissure for venous lig., fossa for gallbladder, groove for vena cava, esophageal and gastric impression, omental tuber, suprarenal and renal impression, duodenal and colic impression

 porta hepatis – common hepatic duct, proper hepatic a., portal v.

Gallbladder  fundus – at level of transpyloric line  body  neck – spiral fold  cystic duct

 bile duct = common hepatic duct + cystic duct

Blood supply: Arteries: proper hepatic a. (gallbladder – cystic a.) Veins: portal v., hepatic vv. Lymph: hepatic lnn., celiac lnn., intestinal trunk, cisterna chyli

Pancreas  head of – pancreatic notch (superior mesenteric vessels), uncinate process  body of pancreas – omental tuber (), anterior, posterior, inferior surface  tail of pancreas – intraperitoneally  pancreatic duct – on major duodenal papilla  accessory pancreatic duct – on minor duodenal papilla

Blood supply: Arteries: pancreatic brr. (superior and inferior pancreaticoduodenal a.), splenic a. Veins: superior mesentaric v., splenic v. Lymph: hepatic lnn. ( head of pancreas), coeliac lnn. ( body and tail of pancreas), pancreaticosplenic lnn. ( head and tail of pancreas)

PERITONEUM

 parietal peritoneum  visceral peritoneum   mesentery  root of mesentery

Peritoneal spaces: intraperitoneal extraperitoneal – retroperitoneal space, praeperitoneal space, subperitoneal space

 excavation (pouch): vesicouterine, rectouterine, rectovesical

Peritoneal cavity  mesentery – root of mesentery  mesocolon – transverse mesocolon, mesoappendix, mesosigmoid, mesorectum – divides peritoneal cavity into: a) supramesocolic part b) inframesocolic part a) supramesocolic part – falciform lig., right and left subphrenic recess, subhepatic recessses, hepatorenal recess – blood supply from coeliac trunk (Th12)  omental bursa: epiploic (Winslow) foramen, vestibule, isthmus, superior and inferior recess, splenic recess  lesser omentum: hepatooesophageal lig., hepatogastric lig., hepatoduodenal lig. – portal v., proper hepatic a., bile duct  : gastrophrenic lig., gastrosplenic lig., gastrocolic lig.

b) inframesocolic part – root of mesentery divides the inframesocolic part into: . right inframesocolic part – blood supply from superior mesenteric a. (L1) . left inframesocolic part – blood supply from inferior mesenteric a. (L3)

Peritoneal recesses:  duodenojejunal flexure: superior and inferior recess, paraduodenal recess (paraduodenal fold – inferior mesenteric v.), retroduodenal recess  ileocaecal orifice: ileocaecal recess – superior and inferior recess, retrocaecal recess  sigmoid colon: intersigmoid recess  ascending and descending colon: medial and lateral paracolic recess

RETROPERITONEUM

Organs: suprarenal , kidney, renal , Arteries and veins: abdominal aorta + branches, inferior vena cava + tributaries Lymphatic structures: iliac and lumbar lymph nodes, cisterna chyli Nerves: lumbar plexus, sympathetic trunk, prevertebral ganglia, autonomic plexuses

Abdominal aorta  Th12-L4  level of iliac crest – bifurcation of aorta  terminal line – dividing of common iliac aa. into external and internal iliac aa.

Parietal branches: . inferior phrenic aa. – superior suprarenal aa. . lumbal aa. . median sacral a.

Visceral paired branches: . middle suprarenal aa. (L1) . renal aa. (L1) – inferior suprarenal aa. . testicular (ovarian) aa. (L2)

Visceral unpaired branches: . coeliac trunk (Th12)  left gastric a. – gastric brr. (lesser curvature), oesophageal brr.  splenic a. – pancreatic brr., splenic brr., short gastric aa. (fundus), left gastroepiploic (gastroomental) a. (greater curvature) – gastric brr, epiploic brr.  common hepatic a.:  proper hepatic a. (hepatoduodenal lig.) – right gastric a., left br., right br. – cystic a. (Callot triangle)  gastroduodenal a. – superior pancreaticoduodenal a., right gastroepiploic (gastroomental) a. (greater curvature) – gastric brr., epiploic brr.

. superior mesenteric a. (L1)  inferior pancreaticoduodenal a. – anterior and posterior br.  jejunal aa. (1-2 arcade) – straight aa.  ileal aa. (3 and more arcade) – straight aa.  ileocolic a. – ileal br., colic br., anterior and posterior caecal a., appendicular a.  right colic a.  middle colic a.

. inferior mesenteric a. (L3)  left colic a.  sigmoid aa.  superior rectal a. (anastomosis with internal iliac a.)

Anastomosis magna Riolani, s. Halleri – anastomosis between middle colic a. and left colic a.

Inferior vena cava  L5-Th8

Parietal tributaries: . common iliac vv. (L5) . lumbal vv. (L1-L4) . inferior phrenic vv.

Visceral tributaries: . renal vv. (L1)  right renal v.  left renal v. – left testicular (ovarian) v., left suprarenal v. . right testicular (ovarian) v. (L2) . right suprarenal v. (L1) . hepatic vv.

Portal  arises behind head of pancreas  superior mesenteric v. + splenic v. ( inferior mesenteric v.) = portal v.

Branches of portal vein  paraumbilical vv.  left gastric v. – oesophageal vv.  right gastric v. – prepyloric v.  superior mesenteric v. – pancreaticoduodenal vv., pancreatic vv., jejunal vv., ileal vv., right gastroepiploic v., ileocolic v. – appendicular v., right colic v., middle colic v.  splenic v. – pancreatic vv., short gastric vv., left gastroepiploic v., inferior mesenteric v. – left colic v., sigmoid vv., superior rectal v.

Lymph vessels and nodes

Parietal:  along aorta: to left lumbar trunk – preaortic lnn., lateroaortic lnn., retroaortic lnn.  along IVC: to right lumbar trunk – precaval lnn., laterocaval lnn., retrocaval lnn., interaortocaval lnn. Visceral:  from abdominal organs: to intestinal trunk – coeliac lnn., superior mesenteric lnn., inferior mesenteric lnn.

Cisterna chyli: lumbar trunks + intestinal trunk

Inervation of retroperitoneum Somatic nerves  subcostal nerves (Th12)  lumbar plexus (L1-L4) – iliohypogastric n. (L1) – ilioinguinal n. (L1)

Autonomic nerves Sympathetic part – from sympathetic trunk  greater splanchnic n. (Th5-Th9), lesser splanchnic n. (Th10-Th11), least splanchnic n. (Th12) – to prevertebral ganglia  lumbar splanchnic nn. – to prevertebral ganglia  prevertebral ganglia – coeliac ganglion, superior mesenteric ganglion, inferior mesenteric ganglion  autonomic plexus – aortic plexus: coeliac plexus, superior mesenteric plexus, intermesenteric plexus, inferior mesenteric plexus  superior hypogastric plexus: right hypogastric n., left hypogastric n.  inferior hypogastric plexus

Parasympathetic part  vagus n.  pelvic splanchnic n. (S2-S4)  autonomic plexus  intramural ganglia

Porto-caval anastomosis

 portal v.  left gastric v. – oesophageal vv.  azygos v.  SVC

lateral thoracic v.  SVC  portal v.  paraumbilical vv. – abd. subcutaneous vv. superficial epigastric v.  IVC

 portal v.  superior rectal v. – middle rectal v.  internal iliac v.  IVC

 portal v.  inferior mesentaric v.  left colic v. – lumbal vv.  IVC

Cavo-caval anastomosis

 SVC  internal thoracic v.  superior epigastric v. – inferior epigastric v.  external iliac v.  IVC

 SVC  lateral thoracic v.  abdominal subcutaneous. vv.  superficial epigastric v.  IVC

 SVC  azygos v.  ascending lumbal v. – lumbal vv.  IVC

URINARY SYSTEM FUNCTION: production of ; excretion, retention of substance ORGANS:

 KIDNEY  MAJOR AND MINOR CALYCES  RENAL PELVIS  URETER 

Kidney: - paired , bean-shaped - primary retroperitoneal organ, lies in level TH12 – L3 - right kidney is inferior to left kidney (because of the presence of the ) - renal hilum in level L1

Coverings:  fibrous capsule, fatty capsule (adipose capsule - perirenal fat), renal fascia – prerenal layer (anterior)/retrorenal layer (posterior), pararenal fat body (corpus adiposum pararenale)

External features:  anterior/posterior surface, superior (upper)/inferior (lower) pole, lateral margin, medial margin – renal hilum – renal sinus

Cross-section:  renal cortex (peripheral area) forms renal columns (with interlobar aa.)  renal medulla (deeper than cortex) contains: renal pyramids – base of pyramids (with arcuate aa.) - renal papilla with papillary foramina (cribriform area) Blood supply, lymphatic drainage, innervation:  renal aa., renal vv.  lumbar l. nn.  Renal plexus – sympathetic and parasympathetic innervation, sensory nerves through TH10-TH12 for innervation of fibrous capsule of kidney

Minor renal calyces: - surround renal papillas, - in renal sinus; primary retroperitoneal organs

Major renal calyces: - a fusion of minor renal calyces - in renal sinus; primary retroperitoneal organs Renal pelvis: - paired organ; a fusion of major renal calyces - in renal sinus and in renal hilum; primary retroperitoneal organ - behind renal v. and renal a. (VAP)

Ureter: - paired organ

Portions:  abdominal portion (is situated retroperitoneally)  pelvic portion (is situated subperitoneally)  intramural portion (in wall of urinary bladder)

Curves + physiologic constrictions:  after leaving renal pelvis  where it crosses on right site: external iliac vessels on left site: common iliac vessels  where it enters urinary bladder  (where it crosses uterine a.)

Blood supply, lymphatic drainage, innervation:  ureteric brr. of renal a., ovarian (testicular) a., uterine a. (a. of deferens duct), vessels of urinary bladder (superior and inferior vesical aa.); veins with same name  lumbar l. nn., internal iliac l. nn.  autonomic i. – renal plexus, ovarian (testicular) plexus, uterovaginal (deferential) plexus, vesical plexus = ureteric plexus; sensory i. - from TH10 – L1 Urinary bladder: - empty bladder has subperitoneal position; full bladder has preperitoneal position

Parts:  apex of bladder  body of bladder  fundus (base) of bladder - trigone of bladder : right/left ureteric orifice internal urethral orifice - uvula of bladder interureteric fold (crest) – retrotrigonal fossa  cervix of bladder

Blood supply, lymphatic drainage, innervation:  superior and inferior vesical aa.; vesical → vesical vv.  paravesical l. nn, prevesical l. nn., retrovesical l. nn., lateral vesical l. nn. → paravesical plexus → internal and external iliac l. nn.  autonomic i. - vesical plexus; sensory i. through TH10 – L1

Female urethra: - origin: internal urethral orifice - the end: external urethral orifice - shorter than male urethra

Parts:  intramural part - in wall of urinary bladder  pelvic part - between bladder and  perineal part - ending: external urethral orifice

Blood supply, lymphatic drainage, innervation:  inferior vesical a., vaginal a., a. of the vestibular bulb; venous blood into vesical, pudendal, uterovaginal venous plexus  paravesical l. nn. → visceral l. nn. → iliac l. nn. and deep inguinal l. nn.  autonomic i. – vesical plexus; motor i. (for sphincter urethrae m.) and sensory i. from pudendal n.

Male urethra: - origin: internal urethral orifice - the end: external urethral orifice

Parts:  intramural part - in wall of urinary bladder  prostatic part - in ; contains structures: prostatic sinus  membranous part – in urogenital diaphragm  spongy part – in spongy body (corpus spongiosum); contains structures: navicular fossa of urethra valve of navicular fossa

Curvatures:  subpubic curvature  prepubic curvature

Blood supply, lymphatic drainage, innervation:  inferior vesical a., middle rectal a., urethral a.; prostatic venous plexus and internal pudendal vv.  visceral l. nn. → pelvic l. nn.; inguinal l. nn  autonomic i. – rectal plexus and prostatic plexus; sensory i. – pudendal n.

MALE FUNCTION: reproduction ORGANS: Internal genital organs:  TESTES   DUCTUS DEFERENS

Accessory sex glands:  SEMINAL VESICALS (GLAND)  PROSTATE 

External genital organs:  SCROTUM 

Testes: - paired organ - during intrauterine development has retroperitoneal position → descent of testes → into scrotum

External features:  superior/inferior pole (extremity), medial/lateral surface, anterior margin, posterior margin – testis

Cross-section:  from → septas of testis, which demarcate lobules of testis (contains convoluted seminiferous tubules)  posterior part of tunica albuginea creates (contains )

Coverings:  tunica albuginea  - visceral layer (epiorchium) → serous cavity of scrotum (cavum vaginale) - parietal layer (periorchium)

Epididymis: - paired organ on posterior margin of testis

External features (parts):  head of epididymis  body of epididymis  tail of epididymis Cross-section:  efferent ductules (in head of epididymis), duct of epididymis (in body and tail of epididymis)

Coverings  tunica vaginalis - visceral layer – continues from testis to epididymis and forms sinus of epididymis, which is bounded by superior and inferior lig. of epididymis - parietal layer

Blood supply, lymphatic drainage and innervation (testes and epididymis):  testicular aa.;  lumbar l. nn.  autonomic i. - testicular plexus, somatic i. – genital br. of genitofemoral n.

Rudimentary structures:   appendix of epididymis

Transport of :  seminiferous convoluted tubules → straight tubules → efferent ductules → ductules of epididymis → ductus deferens

Ductus deferens: - paired organ

Parts:  scrotal part  funicular part  inguinal part  pelvic part

Blood supply, lymphatic drainage and innervation:  a. of ductus deferens; vesical venous plexus  external and internal iliac l. nn.  autonomic i. - deferential plexus

Seminal vesical/seminal glands: - paired exocrine glands, behind fundus of urinary bladder and laterally to ampulla of ductus deferens

Blood supply, lymphatic drainage and innervation:  inferior vesical a.; vesical and prostatic venous plexus  internal iliac l. nn.  autonomic i. – inferior hypogastric plexus

Connection between and male :  ampulla of ductus deferens + excretory duct → , which has opening in seminal colliculus in prostatic part of male urethra Prostate: - unpaired gland, chestnut-shaped

External features and parts:  anterior/posterior/ inferolateral surface  base of prostate  apex of prostate  isthmus of prostate

Cross-section (division according lobes):  anterior/posterior/right/left/middle lobe

Cross-section (division according zones):  anterior fibromuscular/central/peripheral/transitional zone

Coverings:  capsule of prostate  prostatic venous plexus  periprostatic capsule

Blood supply, lymphatic drainage and innervation:  inferior vesical a.; venous prostatic plexus  external and internal iliac l. nn., sacral l. nn.  autonomic i. – prostatic plexus

Bulbourethral gland: - paired gland, posterolaterally to bulb of penis

Spermatic cord: - passes through the inguinal canal

Content:  posteriorly: ductus deferens, a. of ductus deferens, deferential plexus  anteriorly: testicular a., pampiniform plexus, lymphatic vessels, testicular plexus

Coverings:  internal spermatic fascia (derivated from transversalis fascia)  cremasteric m. (derivated from internal oblique abdominal m.) + cremasteric fascia  external spermatic fascia (derivated from deep )  tunica dartos = dartos m. (continuation of Camper´s fascia) + Colle´s fascia (continuation of Scarpa´s fascia)  skin

Scrotum: - contains testes, epididymis and part of spermatic cord - is divided by septum of scrotum, which creates on scrotal raphe

Layers of wall of scrotum:  tunica vaginalis testis (visceral layer/parietal layer) – covering of testis  internal spermatic fascia (derivated from transversalis fascia)  cremasteric m. (derivated from internal oblique abdominal m.) + cremasteric fascia  external spermatic fascia (derivated from deep abdominal fascia)  tunica dartos = dartos m. (continuation of Camper´s fascia) + Colle´s fascia (continuation of Scarpa´s fascia)  skin

Blood supply, lymphatic drainage and innervation:  anterior scrotal brr. from external pudendal aa., posterior scrotal brr. from internal pudendal aa.; anterior and posterior scrotal vv.  superficial inguinal l. nn.  somatic i. - anterior scrotal nn. from ilioninguinal n. - posterior scrotal nn. from pudendal n.

Penis: - copulatory organ - fixed by fundiform lig. of penis suspensory lig. of penis

Parts:  - right and left crus (contains right and left cavernous body/ = corpus cavernosum) - bulb of penis (contains spongy body/ = corpus spongiosum) 

Body of penis is formed by:  right and left cavernous body → divided by septum of penis - contains deep a. of penis  spongy body → ends as glans of penis - contains spongy part of male urethra

External features of body of penis:  dorsal surface (dorsum penis)  urethral surface with raphe of penis (continuation of raphe of scrotum)  glans of penis - corona of glans - neck of glans - external urethral orifice

Coverings of penis:  tunica albuginea of spongy body and tunica albuginea of cavernous bodies → dorsal n. of penis (right and left), dorsal a. of penis (right and left), deep dorsal v. of penis (NAVAN)  deep fascia of penis (Buck´s fascia) → superficial dorsal v. of penis  superficial fascia of penis (Dartos fascia)  skin → creates prepuce of skin - frenulum of prepuce

Blood supply, lymphatic drainage and innervation:  internal pudendal a. and its branches: a . of bulb of penis, urethral a., deep a. of penis, dorsal a. of penis; superficial dorsal v. of penis and deep dorsal v. of penis  superficial inguinal l. nn.  autonomic i. - inferior hypogastric plexus; somatic i. - dorsal n. of penis

FEMALE REPRODUCTIVE SYSTEM FUNCTION: reproduction ORGANS: Internal genital organs:   UTERINE (FALLOPIAN) TUBE  UTERUS 

External genital organs:  PUDENDI  LABIA MINORA PUDENDI

Accessory sex glands:  GREATER VESTIBULAR GLANDS  MINOR VESTIBULAR GLANDS

Erectile tissues:  CLITORIS  BULB OF VESTIBLE

Ovary: - paired organ; is placed in ovarian fossa (in nullipara) or in Claudius fossa (in multipara) - intraperitoneal position - mesovary

External features:  medial/lateral surface, tubal extremity → suspensory lig. of ovary, uterine extremity → proper lig. of ovary, free margin (border), mesovarian margin (border) - hilium of ovary Cross-section:

 tunica albuginea of ovary  ovarian stroma - ovarian cortex - ovarian medulla

Uterine (fallopian) tube: - paired organ, intraperitoneal position -

Parts:  uterine part - uterine opening  isthmus of uterine tube  ampulla of uterine tube  infundibulum of uterine tube - tubal fimbriae → ovarian fimbria (the longest) - abdominal opening of uterine tube Blood supply, lymphatic drainage, innervation (ovary + uterine tube):  ovarian a., ovarian br. of uterine a.; ovarian vv., uterovaginal venous plexus  lumbar l. nn.  autonomic i. - ovarian plexus

Uterus: - intraperitoneal position - - in anteversion and in anteflexion External features:  body of uterus - fundus of uterus - right and left horn of uterus - right and left margin of uterus - cavity of uterus - intestinal/vesical surface  isthmus of uterus  cervix of uterus - inside is canal of cervix of uterus with palmate folds → supravaginal part - internal uterine orifice → vaginal part - external uterine orifice (external os) - anterior/posterior lip

Composition of wall of uterus:  endometrium  myometrium  parametrium - broad lig. of uterus = mesometrium + mesosalpinx + - rectouterine/vesicouterine pouch

Suspensory apparatus of uterus – parametral ligg.:  cardinal lig./sacrouterine (rectouterine) ligg./vesicouterine ligg.  round lig. of uterus – from uterine horns – passes through the inguinal canal

Blood supply, lymphatic drainage, innervation:  uterine a.; uterovaginal venous plexus  lumbar l. nn., internal iliac l. nn., parauterine l. n., sacral l. nn., superficial inguinal l. nn.  autonomic i. – uterovaginal plexus

Vagina: Wall, mucosa and fornix of vagina:  anterior wall - vaginal rugae (transverse folds) - anterior vaginal column (longitudinal fold) - urethral carina of vagina  posterior wall - vaginal rugae (transverse folds) - posterior vaginal column (longitudinal fold)  fornix of vagina - anterior recess (shorter)/posterior recess (longer)/lateral recesses  vaginal orifice - hymen/hymenal caruncules

Blood supply, lymphatic drainage, innervation:  vaginal a., vaginal br. of uterine a.; uterovaginal venous plexus  internal iliac l. nn., superficial inguinal l. nn.  autonomic i. - uterovaginal plexus; somatic i. - pudendal n.

Mons pubis

Labia majora pudendi: - are composed of fatty tissue and venous plexus - with pubic - anteriorly: interconnected by anterior commissure of labia majora - posteriorly: interconnected by posterior commissure of labia majora - between them is rima pudendi

Labia minora pudendi: - medially to labia majora pudendi; are formed by - without pubic hair - anteriorly: interconnection by prepuce of clitoris (outer) frenulum of clitoris (inner) - posteriorly: interconnection by frenulum of labia minora - between them is vaginal vestibule - external urethral orifice - vaginal orifice

Clitoris: Parts:

 right and left  body of clitoris → ends in glans of clitoris

Bulb of vestibule: - erectile tissue underneath labia majora

Greater vestibular glands (Bartholin´s glands): - behind - open to vaginal vestibule

Minor vestibular glands (skene´s glands): - in anterior wall of vagina Blood supply, lymphatic drainage, innervation: (external genital organs + erectile tissues + accessory sex glands)  anterior labial brr. of external pudendal aa., a. of bulb of vestibule, perineal a., dorsal a. of clitoris, posterior labial brr. of internal pudendal a.; external and internal pudendal vv.  superficial inguinal l. nn.  autonomic i. - inferior hypogastric plexus; somatic i. - posterior labial brr. from pudendal n. - anterior labial brr. from ilioinguinal n.

PELVIS pelvis bone – ilium, pubis, ischium; sacrum, + ,

 pelvis inlet (superior aperture) – passing through the promontory, terminate line and the upper margin of the pubic symphysis  pelvic outlet – passing through the coccyx, , pubic symphysis

Content:  organs: part of male and female genital organs, part of urinary organs,  vessels: artery – common iliac a., external iliac a., internal iliac a. + branches, ovarian a. (testicular a.), superior rectal a., middle sacral a. veins – internal iliac v., external iliac v.  lymph nodes: internal/external iliac lymp nodes  innervation: sacral plexus, sympthatetic trunk, autonomic plexus

 greater pelvis – false pelvis  lesser pelvis – true pelvis

 terminal line - consists of the pectineal line (pecten pubis), the arcuate line, the pubic crest, the sacral ala, and the sacral promontory

Pelvic walls ():  ventral – pubic bone, pubic symphysis, superior pubic lig., inferior pubic lig. (arcuate pubic lig.)

 lateral – , obturator membrane, internal obturator m. obturator fascia, obturator canal (obturator a., v., n.), pelvic fascia

 dorsal – sacrum, coccyx, part of ilium, sacroiliac joints, anterior/interosseous/posterior sacroiliac lig., iliolumbal lig., piriformis m., sacral plexus, internal iliac vessels + branches, internal iliac v. + tributaries

Pelvic diaphragm

m. – iliococcygeus m. (tendinous arch of levator ani, obturator fascia), pubococcygeus m., puborectalis m., levator prostatae m. (pubovaginalis m.)

 coccygeal m. – located anterior to the

 external anal sphincter

– the gap between the anteromedial borders of thepelvic diaphragm, pass urethra (♂, ♀), vagina (♀)

Urogenital diaphragma

Consist of:  deep transverse perineal m.  superficial transverse perineal m.  sphincter urethrae m.  transverse perineal m.

Pelvic fascias:  superior fascia of pelvic diaphragm  inferior fascia of pelvic diaphragm (continues to obturator fascia)  superior fascia of urogenital diaphragm  inferior fascia of urogenital diaphragm (perineal membrane)  superficial perineal fascia (Colle´s)

Perineum

 area under the pelvic diaphragm and urogenital diaphragm  borders – bones = pelvic outlet  rhomboid shape: – –

 Central tendon of (perineal body)

Muscles:  ischiocavernosus m.  bulbospongiosus m.  superficial transverse perineal m.  external anal sphincter m.

Ischioanal fossa Borders:  levator ani m., external anal sphincter m.  obturator internus m., ischial tuberosities  deep transverse perineal m.  reaches sacrotuberous lig.  pubic recess (anteriorly)

Content:  pudendal canal (Alcock canal)  internal pudendal a., v.  pudendal n.  depot fat of ischioanal fossa

Arterial blood supply:  ovarian a./testicular a. (abdominal aorta - L2)  superior rectal a. (inferior mesenteric a.) – anastomosis with middle rectal a. (internal iliac a.) and inferior rectal a. (internal pudendal a.)  middle sacral a. (abdominal aorta) – coccygeal body  common iliac a.:  external iliac a.  internal iliac a.

Parietal branches:  iliolumbar a. – anastomosis with deep circumflex iliac a.  lateral sacral aa.  obturator a. – pubic br. anastomosis with obturator br. (inferior epigastric a.) – corona mortis  superior gluteal a.  inferior gluteal a.

Visceral branches:  umbilical a. – superior vesical aa.  uterine a. (ductus deferentis a.)  inferior vesical a.  middle rectal a.  internal pudendal a. – inferior rectal a., perineal a., urethral a., posterior scrotal (labial) brr., bulbi penis a., deep a. of penis (clitoridis), dorsal a. of penis (clidoridis)

Venous drainage:  middle sacral v. (left common iliac v.)  internal iliac v.

 venous plexuses around the organs:  pampiniform plexus  vesical plexus  prostatic plexus  uterin and vaginal plexus  rectal plexus – portocaval anastomosis

Lymphatic drainage  lymph nodes - parietal: iliac (external, internal, common) lumbar, superficial inguinal lymph nodes - visceral

Innervation:  sacral plexus, coccygeal n.  pudendal n. – internal obturator muscle, muscle of pelvic diaphragm  autonimic innervation:  superior hypogastric plexus  inferior hypogastric plexus