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 pubis

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 - epigastrium (regions: epigastric, hypochondriac left and right)

middle - mesogastrium (regions: umbilical, lateral left and right)

inferior - hypogastrium (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 (pylorus, duodenal bulb, fundus of gallbladder, superior mesenteric a.,

cisterna chyli, hilum of kidney, lower border of spinal cord)

transumbilical line – L4

Bones

Lumbar vertebrae (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 sacrum – 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 abdominal wall

1. SKIN

2. SUBCUTANEOUS TISSUE + SUPERFICIAL FASCIAS + SUPRAFASCIAL STRUCTURES

Superficial fascias:

Camper´s fascia (fatty layer) – downward becomes dartos m.

Scarpa´s fascia (membranous layer) – downward becomes superficial perineal fascia of Colles´)

dartos m. + Colles´ fascia = tunica dartos

Suprafascial structures:

Arteries and veins:

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 scrotum 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, rectus sheath (anterior layer, posterior layer) –

arcuate line (Douglas), linea alba

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

(conjoint tendon)

dorsal group:

quadratus lumborum m.

psoas major and minor m.

5. TRANSVERSALIS FASCIA

6. PARIETAL PERITONEUM

- internal surface of anterior abdominal wall

- five peritoneal folds which extend toward the umbilicus:

median umbilical fold – obliterated urachus

supravesical fossa

medial umbilical fold (paired) – obliterated umbilical a.

medial inguinal fossa – superficial inguinal ring

lateral umbilical fold (paired) – inferior epigastric vessels

lateral inguinal fossa – 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 inguinal canal:

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:

♂ spermatic cord, cremasteric a., ilioinguinal n., genital br. of genitofemoral n.

♀ round ligament of the uterus, artery of round lig., ilioinguinal n., genital br. of genitofemoral n.

DIGESTIVE SYSTEM

Oral cavity

Vestibul of mouth

upper lip – nasolabial sulcus, philtrum, 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 lips (angle of mouth), parotid papilla (opening of parotid

duct at the level of 2nd upper molar)

Proper oral cavity

gingiva (gum)

gingival margin

interdental papilla

gingival sulcus

Teeth

superior and inferior dental arches

tooth (dens, odontos) – dental crown (enamel), dental neck (cement), dental root (cement, apex

radicis dentis), pulp cavity, dental pulp

incisors

canines

premolars

molars

Tongue

root of tongue – lingual tonsil, median and lateral glossoepiglottic folds, epiglottic valleculae

body of tongue – median sulcus, terminal sulcus, foramen cecum, vallate papillae, fungiform

papillae, filiform papillae, lingual aponeurosis, lingual septum

apex of tongue

margin of tongue – foliate papillae

inferior surface of tongue – fimbriated fold, frenulum of tongue, sublingual caruncula,

sublingual fold

Muscles of tongue:

extrinsic – genioglossus m., hyoglossus m., palatoglossus m., styloglossus m.

intrinsic – superior and inferior longitudinal mm., transverse muscle of tongue, horizontal

muscle of tongue

Palate

hard palate – transverse palatine folds (rugae palatinae), palatine raphe, incisive papilla, palatine

glands

solf palate – uvula, tensor veli palatini m., levator veli palatini 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. (parotid duct on parotid papilla)

sublingual gl. (minor sublingual duct, major sublingual duct on sublingual

caruncula)

submandibular gl. (submandibular duct on sublingual caruncula)

Oropharyngeal isthmus (fauces)

uvula

palatoglossal arch – triangular fold

palatopharyngeal arch

semilunar fold

tonsilar fossa – palatine tonsil

supratonsillar fossa

Pharynx

nasal part (nasopharynx) – external base of skull 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

pharyngeal raphe

Levatores

stylopharyngeus m.

salpingopharyngeus m.

palatopharyngeus m.

retropharyngeal space, parapharyngeal space

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.)

Lymph: 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 stomach – fornix of stomach

body of stomach – gastric canal, gastric folds, 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 – circular folds, mesentery

Duodenum

superior part (L1) – ampulla (bulb) of duodenum, superior duodenal flexure,

intraperitoneally

descending part (L1-L3) – longitudinal fold of duodenum, major duodenal papilla

(Vater`s) – opens bile duct and pancreatic duct, minor duodenal papilla (Santorini`s) –

opens accessory pancreatic duct, inferior duodenal flexure, retroperitoneally

horizontal part (L1-L3) – retroperitoneally

ascending part (L3-L2) – duodenojejunal flexure

Jejunum/Ileum

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 ileocecal

valve

vermiform appendix – orifice of vermiform appendix, mesoappendix

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

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

mesocolon

Descending colon – from left colic flexure to left iliac crest

Sigmoid colon – 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

anal canal – anal columns, anal sinuses, anal valves, anorectal line, internal and external anal

sphincter 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 pancreas – pancreatic notch (superior mesenteric vessels), uncinate process

body of pancreas – omental tuber (abdominal aorta), 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

peritoneal cavity

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

greater omentum: 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 gland, kidney, renal pelvis, ureter

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 vein

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 urine; excretion, retention of substance

ORGANS:

KIDNEY

MAJOR AND MINOR CALYCES

RENAL PELVIS

URETER

URINARY BLADDER

URETHRA

Kidney:

- paired organ, bean-shaped

- primary retroperitoneal organ, lies in level TH12 – L3

- right kidney is inferior to left kidney (because of the presence of the liver)

- 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 venous plexus → 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 urogenital diaphragm

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 prostate; contains structures:

seminal colliculus

urethral crest

prostatic utricle

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 REPRODUCTIVE SYSTEM

FUNCTION: reproduction

ORGANS:

Internal genital organs:

TESTES

EPIDIDYMIS

DUCTUS DEFERENS

Accessory sex glands:

SEMINAL VESICALS (GLAND)

PROSTATE

BULBOURETHRAL GLAND

External genital organs:

SCROTUM

PENIS

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 – mediastinum testis

Cross-section:

from tunica albuginea → septas of testis, which demarcate lobules of testis

(contains convoluted seminiferous tubules)

posterior part of tunica albuginea creates mediastinum testis (contains rete testis)

Coverings:

tunica albuginea

tunica vaginalis - 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.; pampiniform plexus

lumbar l. nn.

autonomic i. - testicular plexus, somatic i. – genital br. of genitofemoral n.

Rudimentary structures:

appendix of testis

appendix of epididymis

Transport of sperms:

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 male reproductive system and male urinary system:

ampulla of ductus deferens + excretory duct → ejaculatory 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 abdominal fascia)

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:

root of penis - right and left crus (contains right and left cavernous body/

= corpus cavernosum)

- bulb of penis (contains spongy body/ = corpus spongiosum)

body of penis

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:

OVARY

UTERINE (FALLOPIAN) TUBE

UTERUS

VAGINA

External genital organs:

LABIA MAJORA 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 - mesosalpinx

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 - mesometrium

- 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 + mesovarium

- 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 hair

- 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 loose connective tissue

- 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 crus of clitoris

body of clitoris → ends in glans of clitoris

Bulb of vestibule:

- erectile tissue underneath labia majora

Greater vestibular glands (Bartholin´s glands):

- behind bulb of vestibule

- 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, coccyx + sacroiliac joint, pubic symphysis

pelvis inlet (superior aperture) – passing through the promontory, terminate line and the upper

margin of the pubic symphysis

pelvic outlet – passing through the coccyx, ischial tuberosity, pubic symphysis

Content:

organs: part of male and female genital organs, part of urinary organs, rectum

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 (pelvic cavity):

ventral – pubic bone, pubic symphysis, superior pubic lig., inferior pubic lig. (arcuate pubic

lig.)

lateral – hip bone, 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

levator ani 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 sacrospinous ligament

external anal sphincter

urogenital hiatus – 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: – urogenital triangle

– anal triangle

Central tendon of perineum (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