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89 Cards in this Set
- Front
- Back
Rectum
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a. Begins at S3 as a continuation of sigmoid colon
b. Terminates anterior to the coccyx c. Retroperitoneal d. 15 cm long |
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Rectosigmoid junction (teniae coli at junction)
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a. Teniae coli of the sigmoid become a complete outer muscle covering
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Upper 1/3 of rectum
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a. Peritoneum covers the rectum on its anterior and lateral side
b. Pararectal fossae→ areas lateral to rectum |
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Middle 1/3 of rectum
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a. Peritoneum covers only the anterior surface of the rectum
b. Peritoneum is reflected anteriorly to form the rectovesical pouch in the male c. Forms rectouterine pouch in the female |
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Lower 1/3 of rectum
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a. Rectal ampulla
b. No peritoneal covering |
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Rectovesical septum/rectovaginal septum
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i. Separates the rectum from the prostate or vagina, respectively
ii. Part of lower 1/3 of rectum |
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Rectum shape
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a. Follows sacral curvature
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Transverse rectal folds
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a. 3 frontal plane curves
b. Occur at site where internally the rectum has mucosal infoldings |
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Location of transverse rectal folds
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a. Upper and lower valves are on left side
b. Middle on right side c. Help to support the fecal matter as it accumulates in the rectum |
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Puborectalis muscle
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a. Forms a sling around the rectum at the rectoanal junction
b. Causes 90 degree bend between rectum and anal canal c. “Perineal flexure” |
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Anal canal
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a. Continuation of the rectum
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Anal columns
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i. Ridges in upper ½ of anal canal
ii. Separated by anal sinuses |
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Anal valves
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i. Connect lower ends of anal columns
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Pectinate line
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i. Continuous, scalloped ring of anal valves
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Pecten
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i. Transition region just below the pectinate line
ii. Extends inferiorly to level of intersphincteric groove |
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White line
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i. At level of intersphincteric groove
ii. Inferior border of pectin |
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Anal verge
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i. Area below white line
ii. Extends to external opening |
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Muscular coat of rectum
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i. Consists of inner circular layer and outer longitudinal layer
ii. Continues into anal canal |
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Internal anal sphincter
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i. Made of lowermost fibers of inner circular coat
ii. Covers upper 2/3 of anal canal down to intersphincteric groove (white line) iii. Involuntary |
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Corrugator cutis
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i. Longitudinal muscle fibers that extend to the skin around anus
ii. Cause “puckered” appearance |
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External anal sphincter
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i. Covers entire length of anal canal
ii. Voluntary striated muscle |
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Subcutaneous part of external anal sphincter
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1. Inferior to internal sphincter
2. Encircles the anus 3. No bony attachments |
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Intersphincteric groove of external anal sphincter
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a. White line
b. Formed by junction of subcutaneous part of external sphincter and internal sphincter |
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Deep part of external anal sphincter
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1. Overlaps the internal sphincter
2. Encircles the anal canal 3. Fused to puborectalis |
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Anorectal ring
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a. Portion of deep part of external anal sphincter
b. Palpable above intersphincteric groove |
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Superior rectal artery
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i. Branch of inferior mesenteric artery
ii. Divides into a right and left branch to supply rectum iii. Main supply to rectum iv. Anastomose with branches of middle and inferior rectal arteries |
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Terminal branches of superior rectal artery
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1. Form ridges under the mucosa that→ “anal columns”
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Middle rectal arteries
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i. Branches of internal iliac arteries
ii. Supply only muscle layers |
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Inferior rectal arteries
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i. Branches of the internal pudendal arteries that cross the ischioanal fossa along the obturator internus muscle
ii. Supply the anal canal |
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Venous drainage
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a. To both portal and caval systems
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Superior rectal veins
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i. Accompany arteries and help form anal columns
ii. Drain into IMV→ portal system |
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Internal hemorrhoids
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1. Variscosities in the superior retal veins deep to anal columns frorm internal hemorrhoids
2. Not painful |
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Middle rectal veins
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i. Drain musculature and empty into internal iliac vein→ caval system
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Inferior rectal veins
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i. In anal canal
ii. Drain via the internal pudendal vein→ caval |
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External hemorrhoids
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1. Engorgement or thrombosis of inferior rectal veins
2. Painful |
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Pelvic plexus
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i. Both motor and sensory innervation to rectum and anal canal
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Pelvic splanchnic nerves
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i. Parasympathetic fibers from S2-S4
ii. Join pelvic plexus iii. Increase peristaltic activity |
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Automatic emptying of bowel prevention
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i. Contraction of voluntary muscle fibers in external anal spincter
ii. Via branches of pudendal nerve |
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Nerves in charge of reflex control in rectum/anus
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i. Sensory fibers arising form S2-S4
ii. Continence and defecation |
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Upper 1/2 of anal canal innervation
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i. Pelvic autonomic fibers
ii. Sensitive to stretching but not cutting |
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Lower 1/2 of anal canal innervation
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i. Branches of inferior rectal nerves from pudendal nerve
ii. Sensitive to pain, temperature, touch, pressure, cutting, and pricking |
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Peritoneum on superior surface of bladder
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i. Covered by visceral peritoneum
ii. Reflected anteriorly over anterior abdominal wall as parietal peritoneum iii. Female→ posteriorly over uterus iv. Male→ covers base of bladder before reflecting over anterior surface of rectum |
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Paravesical fossae
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1. Lateral reflections of peritoneum from bladder to lateral pelvic wall
2. Allow bladder to distend laterally |
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Puboprostatic ligament/pubovesical ligament
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1. Male/female
2. Connects neck of bladder to pubic vone 3. Considered visceral pelvic fascia |
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Base of male bladder
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1. Two ductus deferens
2. Seminal vesicles 3. Separated from rectum by rectoprostatic fascia |
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Base of female bladder
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1. Base of bladder abuts anterior wall of vagina
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Vesical trigone
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1. Triangular area formed by 2 opeinings of ureters and their interconnecting ridge to internal orifice of urethra
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Interureteric ridge
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a. Runs between opening of each respective ureter
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Mucosa over trigone
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a. Smooth
b. Elsewhere in has numerous rugae |
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Ureter entry to bladder
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a. Oblique angle
b. Contraction of bladder musculature functions as a physiological sphincter preventing urine reflex |
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Uvula
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a. Projection on the trigone
b. Created by underlying median lobe of prostate |
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Detrusor muscle
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1. Consists of smooth muscle with fibers coursing longitudinally, transversely, and obliquely
2. Motor innervation by pelvic splanchnic nerves |
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Superior vesical arteries
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1. 2-3 small branches from umbilical arteries
2. Supply superior surface of bladder |
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Inferior vesical arteries
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1. Usually branches of internal iliac artery in male
2. Prostate usually receives branches from inferior vesical artery 3. In female, it is usually an unnamed branch of vaginal artery |
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Vesical venous plexus in males
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a. Continuous with the prostatic venous plexus
b. Drains mainly into internal iliac vein c. May communicate with internal vertebral venous plexus |
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Female urethra
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i. Short tube
ii. Fused to anterior wall of vagina |
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Smooth muscle in female urethra
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1. Derived from bladder
2. Forms internal sphincter 3. Involuntary |
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Striated muscle in female urethra
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1. In urogenital diaphragm
2. Forms external sphincter 3. Voluntary |
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Prostatic male urethra
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1. First portion
2. Courses through the prostate 3. Urethral crest on posterior surface |
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Prostatic sinuses
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a. Depression bilateral to urethral crest
b. Prostatic ducts open into urethra |
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Seminal colliculus
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a. Enlargement of urethral crest 2/3 of distance down
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Prostatic utricle
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a. Blind depression about halfway down on colliculus
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Ejaculatory ducts
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a. Two
b. Open on either side of utricle |
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Membranous urethra
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i. Passes through UG diaphragm and perineal membrane
ii. Shortest, narrowest, least distensible part iii. Walls are the thinnest of entire urethra iv. Enters the superior aspect of bulb of the penis |
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Spongy urethra
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i. Extends through the bulb and corpus spongiosum from perineal membrane to external opening
ii. Makes 90 degree turn within the bulb anteriorly |
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Navicular fossa
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1. Dilated part within the glans
2. May have a small mucosal valve proximally 3. Lacuna magna→ mucosal pit in roof (catheter) 4. Meatus→ external orifice |
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Bulbourethral glands
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a. Embedded in deep perineal pouch
b. Lateral to membranous part of urethra c. Associated ducts pass into the bulb of the penis to dump lubricating pre-ejaculates into spongy urethra d. Greater vestibular glands in female |
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Apex of prostate
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i. Rests on pelvic diaphragm
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Base of prostate
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i. Contact with neck of bladder
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Periurethral zone of prostate
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i. Surrounds prostatic urethra
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Central zone in prostate
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i. 25% of glandular tissue of prostate
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Peripheral zone of prostate
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i. 70% of glandular tissue
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Benign prostatic hypertrophy
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i. Enlargement of glands in posterior median lobe leads to compression of urethra
ii. Micturation becomes difficult iii. Prostate cancer in glands of posterolateral lobes does not necessarily lead to micturition difficultiy |
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Blood supply to prostate
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i. Branches of internal iliac artery
ii. Especially the inferior vesical |
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Prostatic plexus
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1. Drains mainly into internal iliac vein
2. May drain into internal vertebral venous plexus (no valves) 3. Path for metastatic prostate cancer |
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Deep dorsal vein of penis
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1. Drains into prostatic plexus
2. Provides direct access from outside of body to pelvic cavity |
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Prostatic plexus of nerves
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1. Encircles and embeds within the prostatic fascial sheath
2. Derived from inferior hypogastric plexus 3. Innervation via sympathetic fibers |
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Parietal pelvic fascia
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i. Membranous
ii. Continuation of transversalis fascia iii. Covers walls and floors of pelvis iv. Attaches to bones of lateral pelvic wall v. Forms white line at superior edge of levator ani |
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Visceral pelvic fascia
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i. Reflects onto and fully invests the pelvic viscera
ii. Continuous with parietal fascia iii. Puboprostatic and pubovesical igaments |
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Endopelvic fascia
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i. Loose areolar, fatty tissue with lymphatics and vessels
ii. Found in gaps between parietal and visceral pelvic fascia and pelvic walls |
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Cardinal ligaments
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a. From cervix and upper vagina to pelvic walls
b. Rectovesical septum in males |
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Lateral ligaments of rectum
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a. From cervix to ala of sacrum
b. Forms pouch of douglas |
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Lateral ligaments of bladder
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a. From cardinal ligament to pubis to sling the bladder
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Testes
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a. Left lower than right
b. Scrotal ligament i. Remnant of gubernaculum ii. Attaches testes to scrotum |
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Tunica albuginea
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i. Surrounds testes
ii. Send septa into testis to form lobules |
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Seminiferous tubules
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i. 1-3 coiled tubules in each lobule
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Rete testis
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i. Opening of tubules
ii. Collecting chamber |
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Efferent ductules
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i. Connect rete testis to epididymis
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Testicular descent
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i. Retroperitoneal
ii. Processus vaginalis-- testicle comes in behind it |