ENDOCRINE SYSTEM

o Thyroid gland
 Largest endocrine gland, visceral neck (10-20 grams)
 Controls metabolism (thyroid hormones), controls calcium metabolism (calcitonin)
 INFERIOR to larynx, ANTERIOR to trachea
 Embryology: derived from 1st and 2nd pharyngeal pouch
 Covered externally by visceral fascia of PRETRACHEAL LAYER of deep cervical fascia
 Attaches it to laryngoskeleton by: anterior suspensory ligament and posterior suspensory
ligament (berry’s)
 Anterior to C5 – T1 vertibrae
 Forms part of the floor of anterior cervical region
 2 lobes joined by isthmus at 2nd and 3rd tracheal rings
 Base found at 4th and 5th tracheal rings
 3 surfaces
 Lateral – sternohyoid, superior belly of omohyoid, sternothyroid, anterior boarder of
sternocleidomastoid
 Medial
 Upper
o Anterior – thyroid cartilage, cricoid cartilage, cricothyroid muscle
o Posterior – external laryngeal nerve, inferior constrictor muscle, esophagus
 Lower
o Anterior – trachea
o Posterior – recurrent laryngeal nerve
 BORDERS
 Anterior – superior thyroid artery, anterior branch
 Posterior – inferior thyroid artery, anastomosis between superior and inferior
thyroid arteries, parathyroid glands, thoracic duct (left side)
 BLOOD SUPPLY
 Superior thyroid artery
o From external carotid artery
o Supplies anterosuperior aspect
o Associate with superior laryngeal nerve
 Inferior thyroid artery
o From thyrocervical artery
o Supplies posteroinferior aspect
o Associate with recurrent laryngeal nerve (damaged from potential injury)
 Thyroid ima artery (only 3% have this)
o From brachiocephalic trunk
o Supplies the isthmus
 VENOUS DRAINAGE
 Superior thyroid vein
o Drains superior pole
o Tributary to the internal jugular vein
  Middle thyroid vein
o Drains middle portion of the lobe
o Tributary to the internal jugular vein
 Inferior thyroid vein
o Drains inferior lobe
o Tributary to the brachiocephalic vein
 LYMPHATIC DRAINAGE – Prelaryngeal, Pretracheal and Paratracheal lymph node ->
superior and inferior deep cervical lymph node
 NERVE SUPPLY – superior , middle and inferior cervial ganglia -> superior and inferior
thyroid periarterial plexuses, and cardiac plexus
o Parathyroid gland
 Posterior to thyroid gland (weighs 35 to 50mg)
 Embrayology: derived from 3rd and 4th pharyngeal pouch
 Cotrols calcium and phosphorus metabolism (parahormone/PTH)
 SUPERIOR PARATHYROID GLANDS
 Located on the posteriolateral surface of superior pole of thyroid lobe. 1cm superior
to the entry of inferior thyroid artery, inferior border of cricoid.
 Under the thyroid superficial fascia, posterior to RLN
 BLOOD SUPPLY
 Inferior thyroid artery
 Venous drainage
 Thyroid plexus of veins
 Lymphatic drainage
 Similar to thyroid gland -> deep cervical and paratracheal lymph nodes
 Nerve supply
 Thyroid branches of the cervical sympathetic ganglia
 Vasomotor rather than secretomotor
 Hormonally regulated
o SALIVARY GLAND – PAROTID GLAND
 Largest salivary gland (15-30 grams)
 Serous secretion (ptyalin) – 20% total salivary content
 In between the mandible and sternocleidomastoid muscle, below the external acoustic
meatus (inverted 3-sided pyramid)
 BORDERS
 Superior border – zygomatic arch
 Inferior border – mandible
 Posterior border – sternocleidomastoid and external ear
 Anterior border – masseter
 Medial border – buccinator
 Structures that pierces the gland (deep – superficial)
 Auriculotemporal nerve
 External carotid artery
 Retromandibular vein and facial nerve
 Parotid gland – stensen’s duct – 5cm long
 Runs on masseter muscle -> pierces buccinators muscle -> turns medial and opens
opposite the crown of upper 2nd molar
 Opening corresponds to middle 1/3rd of a line drawn from lower border of tragus to
a point midway between the ala nasi and upper labial margin
 BLOOD SUPPLY
 Superficial temporal artery – transverse facial artery
 Maxillary artery
 VENOUS DRAINAGE
 Retomandibular vein – from UNION of superficial temporal and maxillary veins
 Posterior facial vein –lied deep to the marginal mandibular branch of facial nerve.
Used as a landmark to ID nerve
 NERVE SUPPLY
 Receives sensory and autonomic innervation
o Sensory innervation by the auriculotemporal nerve, a branch of mandibular
nerve (V3)
o Great auricular nerve – innervates skin and parotid gland
o Parasympathetic innervation begins with glossopharyngeal nerve (CN IX) ->
synapses with the otic ganglion -> auriculotemporal nerve -> parotid gland
o Increase saliva production
o Sympathetic innervation from the superior cervical ganglion -> fibers travel
along the external carotid artery -> parotid gland
o Inhibits saliva secretion, via vasoconstriction
 FACIAL NERVE – emerges from stylomastoid foramen
 Pierces posteromedial surface of the parotid gland -> radiates between the
superficial and deep lobes of the gland in a “goose-foot appearance” = pes
anserinus
 POSTERIOR AURICULAR BRANCH – 1st branch, courses posterior and superiorly, both
motor and sensory (parasympathetic)
 Facial nerve – located superficial to retromandibular vein and external carotid
artery
o 2 trunks
 Temporofacial trunk – temporal branch and zygomatic branch
 Cervicofacial trunk – upper buccal/ zygomatic branch, lower buccal/
zygomatic branch, marginal mandibular branch, cervical branch
o SUPRARENAL GLAND – Adrenal gland
 Right suprarenal gland
 More apical/ PYRAMIDAL
 Anterolateral – right crux of diaphragm and liver
 Anteromedially – vena cava
 Left suprarenal gland
 CRESENT/ SEMILUNAR shaped
 Medial – to superior pole of left kidney
  Anteromedial – left crus of diaphragm and pancreas
 Anterolateral – spleen and stomach
 Structures in between the R and L suprarenal glands
 Inferior vena cava
 Right crus of diaphragm
 Celiac ganglion
 Celiac trunk
 Superior mesenteric artery
 Left crus of diaphragm
 Hilum – veins and lymphatics exits
 Cortex – mesoderm origin. releases (SEX – Salt, Energy, seX steroids)
 Mineralocorticoids (ALDOSTERONE – retain water and salt)
o From zona glomeulosa
 Glucocorticoids (CORTISOL, CORTICOSTERONE – metabolism, Energy)
o From zona faciculata
 Androgens (sex steroids)
o Zona reticularis
 Medulla – ectoderm in origin
 Associated with sympatheric nervous system
 Chromaffin cells – catecholamines (epinephrine, norepinephrine)
 BLOOD SUPPLY
 Suprarenal arteries – 50-60 branches penetrates the capsule of the gland
 From 3 sources
o Superior suprarenal arteries – from inferior phrenic arteries
o Middle suprarenal arteries – from abdominal aorta, anastomose with
superior and inferior suprarenal arteries
o Inferior suprarenal arteries – from renal arteries
 VENOUS DRAINAGE
 Right suprarenal vein – SHORT, drains to inferior vena cava
 Left suprarenal vein – LONGER, joins inferior phrenic vein before it drains to left
renal vein
 LYMPHATIC DRAINAGE – lymphatic plexus within the capsule and within the medulla,
drains to the LUMBAR LN
 NERVE SUPPLY – from CELIAC PLEXUS and ABDOMINOPELVIC SPLANCHNIC nerves
o PANCREAS
 Accessory digestive gland, lies retroperitoneally at the level of transpyloric plane (L1 and
L2) on the posterior abdominal wall
 Posterior to the stomach between the duodenum on the right and spleen on the left
 Exocrine secretion (pancreatic juice from the acinar cells)
 Endocrine secretions (glucagon and insulin from pancreatic islet of langerhans)
 HEAD – found at the C-shaped curve of duodenum to the right of the superior
mesenteric vessels, just inferior to the transpyloric plane. Uncinate process extends
 medially to the left, posterior to the SMA. The pancreatic head lies posteriorly on
the IVC, R renal artery and vein, and left renal vein.
 NECK – short (1.5 -2cm), overlies the superior mesenteric vessels. The anterior
surface of the neck is covered with peritoneum, is adjacent to the pylorus of the
stomach. The SMV joins the splenic vein posterior to the neck to form the hepatic
portal vein.
 BODY – lies to the left of the superior mesenteric vessels, passing over the aortal
and L2 vertebra, just above the transpyloric plane, posterior to the omental bursa.
Anterior surface is covered by peritoneum while the posterior surface has no
peritoneum and is in contact with the aorta, SMA, left suprarenal gland, left kidney
and renal vessels
 TAIL – lies anterior to the left kidney, closely related to the splenic hilum and the left
colic flexure. Relatively mobile and passes between the layers of splenorenal
ligament with the splenic vessels.
 Main pancreatic duct – begins at the tail to the head runs through the parenchyma of the
gland, here it turns inferiorly and is closely related to the bile duct.
 Hepatopancreatic ampulla (of Vater) – main pancreatic duct + bile duct. Opens into the
descending part of duodenum at the summit of the major duodenal papilla.
Hepatopancreatic sphincter (of Oddi) – smooth muscle sphincter that contol the flow of
bile and pancreatic juice to ampulla
 Accessory pancreatic duct – opens into the duodenum at the summit of the minor
duodenal papilla. In some cases the main pancreatic duct is smaller than the accessory
pancreatic duct, in such cases; the accessory duct carries most of the pancreatic juice.
 BLOOD SUPPLY – derived mainly from the branches of splenic artery
 Multiple pancreatic arteries form several arcades with pancreatic branches of the
gastroduodenal and superior mesenteric arteries.
 Head – anterior and posterior superior pancreaticoduodenal arteries(branches of
gastroduodenal artery), and the anterior and posterior inferior
pancreaticoduodenal arteries (branch of SMA)
 VENOUS DRAINAGE – via corresponding pancreatic veins, tributaries of the splenic and
superior mesenteric parts of the hepatic portal vein ; most empty into the splenic vein
 LYMPHATIC DRAINAGE – pancreatic lymphatic vessels end in pancreaticosplenic lymph
nodes. Some also end in the pyloric lymph nodes. Efferent vessels from these nodes drain
to the superior mesenteric lymph nodes or to the celiac lymph nodes via hepatic lymph
nodes
 NERVES – derived from the vagus and abdominopelvic splanchnic nerves passing through
the diaphragm.
 Parasympathetic fibers – secretomotor, but pancreatic secretion is primarily
mediated by secretin and cholecystokinin.
o PITUIRARY GLAND – aka. Hypophesis (1cm, 0.5 -1 gram)
 Lies in the sella turcica, connected to the hypothalamus by the pituitary/ hypo[hysial stalk
 Physiologically divided into: anterior (adenohypohysis) and posterior (neurohypophysis).
Between is a small avascular zone called pars intermedia
 Anterior pituitary (adenohypophysis) – master gland. Regulates many other endocrine
glands. Releases: GH, TSH, ACTH, FSH, LH, prolactin
 Posterior pituitary – releases anti-diuretic hormone (vasopressin) and oxytocin
 BLOOD SUPPY – superior and inferior hypophyseal arteries (branches of internal carotid
artery)
 VEINS – hypophyseal veins drain into cavernous sinuses
o PINEAL GLAND – attached to the roof of the 3rd ventricle of the brain, secrete melatonin

REPRODUCTIVE SYSTEM
MALE
o Scrotum
 Inferior to penis, anterior to the anal opening
 Contents: testes, epididymides, and spermatic cord
 Layers: skin, DECIT
 Skin
 Superficial fascia
o Dartos muscle – smooth muscle, replaces the camper’s fascia (fatty) of
anterior abdominal wall
o Colle’s fascia – replaces scarpa’s facia (membranous)
 External spermatic fascia – from the external oblique muscle
 Cremasteric fascia – from the internal oblique muscle, supplied by genital branch of
genitofemoral nerve. Stroking the medial aspect of the thigh -> contract cremasteric
– cremasteric reflex
 Internal spermatic fascia – from the transversalis fascia
 Tunica vaginalis – a closed sac that covers the anterior, medial and lateral surfaces
of each testis
 BLOOD SUPPLY
 Anterior scrotal arteries – terminal branch of external pudendal arteries (from the
femoral artery) SUPPLY – ANTERIOR aspect
 Posterior scrotal arteries – terminal branch of superficial perineal branch of internal
pudendal arteries (from internal iliac artery) SUPPLY – POSTERIOR aspect
 Cremasteric arteries – from inferior epigastric arteries, minor supply
 VENOUS DRAINAGE – drains to the external pudendal veins. Promotes heat loss and
environmental control for the testes
 LYMPHATIC DRAINAGE – drains to the superficial inguinal lymph nodes
 NERVE SUPPLY
 Anterior scrotal nerves – from ilioinguinal nerve and genital branch of the
genitofemoral nerve (lumbar plexus)
 Posterior scrotal nerves – from branches of superficial perineal branches of of the
pudendal nerve and the perineal branch of the posterior femoral cutaneous nerve
(sacral plexus)
o PENIS
 Root – fixed in superficial perineal pouch.
 3 erectile tissues:
 Bulb of the penis – midline. Covered by bulbospongiosus
 Right and left crura of the penis – sides of pubic arch. Covered by ischiocavernosus
 Body – suspended from symphysis pubis (no muscles)
 Corpus spongiosum – from bulb of penis. Expanded ends = glans penis
 Corpora cavernosa – contains spongy urethra. Fibrous outer covering of each corpus
= tunica albuginea. Separated by each other by septum penis
 Buck’s fascia – a coninuation of deep perineal fascia that runs superficail to tunica
albuginea, binds the corpora together
 Glans
 Corona – glans margin beyond the ends o corpora cavernosa
 Neck – an oblique groove constriction
 External urethral opening
 Skin (EXTERNAL PENILE STRUCTURES)
 Prepuce/ foreskin – double layer skin from the neck of glans penis
 Fenulum – median fold from the deep layer of the prepuce to the urethral surface
of the glans
 Preputial sac – between the glans and prepuce. Where the smegma accumulates
 BLOOD SUPPLY –external pudendal artery and internal pudendal artery:
 Dorsal arteries – supplies fibrous tissue around corpora, spongy urethra and skin
 Deep arteries – supplies corpora cavernosa (for erection)
 Arteries of the bulb of the penis – supply the posterior (bulbous) part of corpus
spongiosum and the urethra within it and bulbourethral gland
 VENOUS DRAINAGE
 From cavenous space: penile venous plexus – deep dorsal vein – prostatic venous
plexus – internal iliac vein
 From superficial: superficial dorsal vein of the penis – superficial external pudendal
vein
 LYMPHATIC DRAINAGE
 Superficial inguinal lymph nodes – drains skin
 Deep inguinal and external iliac lymph nodes – drain glans and distal spongy urethra
 Internal iliac lymph nodes – cavernous bodies and proximal spongy urethra
 NERVE SUPPLY
 From S2-S4 spinal cord segments -> pelvic splanchnic nerves (parasympathetic)
 From spinal ganglia -> pudendal nerve (somatic)
o TESTES – male gonads, produces male germ cells and male hormones (testosterone). Suspended in
the scrotum (left is more inferior than the right)
 Tunica albuginea – surrounds the testes. MEDIASTINUM of the testis – extends fibrous
septa separating lobules of seminiferous tubules -> joined by straight tubules towards the
network of canals in mediastinum -> rete testis
  Cavity of tunica viginalis – separates the visceral and parietal layers. With small amount of
fluid. Allowing testicular movement within the scrotum
 BLOOD SUPPLY – TESTICULAR ARTERIES
 From abdominal aorta, infrarenal
 Courses retroperitoneeally crosses ureters and external iliac arteries -> enters
inguinal canal -> enters spermatic cord -> testes
 Anastomose with artery of ductus deferens
 VENOUS DRAINAGE
 Pampiniform venous plexus – from testis and epidydimis. Converge superiorly as
testicular veins
 Right testicular vein – enters inferior vena cave
 Left testicular vein – left renal vein
 LYMPHATIC DRAINAGE – follows the testicular artery and vein.
 Right and left lumbar (caval/aortic)
 Preaortic lymph nodes
 NERVE SUPPLY – autonomic nerves
 Testicular plexus of nerves on the testicular artery contains: vagal parasympathetic
fibers, visceral afferent nerves, and sympathetic fibers from the T7 segment of the
spinal cord
o EPIDIDYMIDES – elongated structure behind the testis
 Compact convolution of ducts of epididymis, ends at ductus deferens
 Receives sperms from testis via efferent ductules
 Storage of sperm, allows maturation of sperm
 Parts:
 Head – superior pole, expanded by lobules of 12-14 coiled efferent ductules
 Body – convoluted duct of epididymis
 Tail – inferior pole, continuous with ductus deferens
 Neurovascular and venous and lymphatic drainage is similar with testes
o DUCTUS DEFERENS – aka. Vas deferens, deferent ducts
 Thick walled tube (18 inches/ 45 cm long)
 Transport mature sperm from the epididymis to the ejaculatory duct and the urethra
 Course:
 Tail of epididymis
 Ascends, part of spermatic cord
 Enters inguinal canal
 Crosses external iliac vessels
 Enters pelvis, lateral wall
 Crosses superior to ureter
 Joins seminal vesicle -> ejaculatory duct
 Ampulla – dilated terminal part
 BLOOD SUPPLY – artery to ductus deferens – from superior or inferior vesical artery.
Terminates and anastomoses with testicular artery behind testis
  VENOUS DRAINAGE – testicular vein, distal pampiniform plexus, vesicular/ prostatic venous
plexus (terminal portion of ductus deferens)
 LYMPHATIC DRAINAGE – drains to external iliac lymph nodes
o SEMINAL GLANS – aka. Seminal vesicles
 Lobulated, 2 inches/ 5cm long
 Secretes a thick alkaline fluid with FRUCTOSE and a COAGULATING AGENT that mixes with
the sperms
 Relations:
 Medially – ampulla of ductus deferens
 Anterior and superiorly – distal ureter and fundus of urinary bladder (separated by
rectovesical pouch)
 Posteriorly and inferiorly – rectum ( Separated by rectovesical septum)
 Joins ductus deferens to form ejaculatory duct
 BLOOD SUPPLY
 Inferior vesical artery – from anterior division of internal iliac artery
 Middle rectal artery – from anterior division of internal iliac artery
 VENOUS DRAINAGE – drains to internal iliac veins
 LYMPHATIC DRAINAGE
 External iliac nodes – superior part
 Internal iliac nodes – inferior parts
o PROSTATE GLAND – largest accessory gland of the male reproductive system, conical. Surrounds
the prostatic urethra.
 Produces thin, milky fluid (citric acid and acid phosphatase) alkaline – neutralizes acidity in
the vagina
 Prostatic sheath – form the visceral layer of pelvic fascia, surrounds the capsule, continuous
anteriorly with puboprostatic ligament
 Parts: glandular (2/3rd) and fibromuscular (1/3rd)
 RELATIONS:
 Superiorly – UB neck ( base of prostate gland)
 Inferiorly – urogenital diaphragm, superior aspect of the urethral sphincter and
deep perineal muscles (apex of prostate gland)
 Anteriorly – symphysis pubis, fat in the space of retzius, attach to pubic bones by
the fascial puboprostatic ligaments
 Posteriorly – rectal ampulla, separated from it by the rectovesical septum (fascia of
Denovillers)
 Laterally – held by anterior fibers of the levator ani
 LOBES:
 Isthmus – anterior lobe/ commissure of prostate
 Inferoposterior – posterior lobe. Palpable by digital rectal examination
 Right and left lobes – lateral lobes, sides of urethra, MAJOR part of prostate
 Middle – median lobe. Enlargement -> formation of the uvula in the urethral orifice
 Peripheral zone – most common site of adenocarcinoma of the prostate gland
 
BLOOD SUPPLY – branches of internal iliac artery:
 Inferior vesical artery, internal pudendal artery, and middle rectal artery
 VENOUS DRAINAGE – prostatic venous plexus
 Drains to inferior vesical and internal pudendal veins -> internal iliac veins
 Receives drainage from deep dorsal vein of penis
 Communicates superiorly to vesical venous plexus
 Communicates posteriorly to internal vertebral venous plexus
 LYMPHATIC DRAINAGE – internal iliac lymph nodes and sacral nodes
 NERVE SUPPLY – inferior hypogastric plexuses and sympathetic nerves ( stimulate the
smooth muscle of the prostate during ejaculation)
o BULBOURETHRAL GLANDS – aka cowper glands.
 Duct open at the penile urethra
 Produce clear fluid that washes out urethra during sexual arousal, before ejaculation
FEMALE
o OVARIES – almond shaped glands close to lateral pelvic wall, suspended by MESOVARIUM of
BROAD LIGAMENT
 LIGAMENTS:
 Suspensory ligament of ovary – attachment to lateral pelvic walls, carries ovarian vessels,
lymphatics and nerves from the ovary
 Ovarian ligament – attaches ovary to the uterus. REMNANT of ovarian gubernaculums in
fetus
 BLOOD SUPPLY – OVARIAN ARTERIES
 From abdominal aorta, bifurcates into: ovarian branch and tubal branch,
anastomose with branches of uterine artery
 VENOUS DRAINAGE
 Pampiniform plexus of veins -> ovarian vein
 Right ovarian vein -> inferior vena cava
 Left ovarian vein -> left renal vein
 LYMPHATIC DRAINAGE – ovarian lymph nodes -> lumbar lymph nodes
 INNERVATION: ovarian plexus and uterine plexus.
 Visceral afferent pain: T11- L1
 Visceral afferent reflex – S2-S4
o UTERUS – thick walled, pear shaped hollow muscular organ
 Within the lesser pelvis on top of the urinary bladder
 Anteverted – uterurs tipped anterosuperiorly in relation to vaginal axis
 Anteflexed – utirine body is bent anteriorly
 Non – gravid uterurs – 7.5 cm long, 5cm wide and 2cm thick (weighs 90grams)
 Parts:
 Body – upper 2/3
o Fundus – rounded part, lies above the orifice of fallopian tubes
o Isthmus – constricted part just above the cervix
 Cervix – lower 1/3
o Cylindrical, narrow part that protrudes into vagina
 Uterine cornu – superolateral extensions where fallopian tubes enter
 Layers:
 Perimetrium – serosa (peritoneum) and loose areolar connective tissue
 Myometrium – smooth muscle
 Endometrium – internal epithelium
o CERVIX – 2.5cm long
 Parts:
 Supravaginal – cul de sac of douglas
 Vaginal – protrudes thru vagina
 Openings:
 Internal Os – uterine cavity
 External os – with vagina
o LIGAMENTS
 1.) Broad ligament – double layer of peritoneum (mesentery), extends to form sides of
uterus to the lateral wall and floor of pelvis. Assist to keep in position
 Ligament of the ovary – lies posterosuperiorly
 Round ligament of uterus – lies anteroinferiorly
 Uterine tube – lies anterosuperior free border with a small mesentery called mesosalpinx
 Mesometrium – largest part of broad ligament, mesentery of uterus
 SUPPORTS UTERUS POSITION:
 Dynamic/ active support – PELVIC DIAPHRAGM. Tone during sitting and standing and active
contraction during periods of increased intraabdominal pressure
 Passive support – by its anteverted and anteflexed postiton. An increase intraabdominal
pressure uterus is pressed against bladder
 2.) transverse cervical (cardinal) ligaments/ lateral cervical (mackenrodt’s) ligaments –
extends from supravaginalcervix and lateral vaginal fornix to lateral pelvic walls. Uterine
arteries run on its superior part
 3.) uterosacral ligament (posterior) – extends from cervix to middle of sacrum. Palpable
during rectal exam
 4.) round ligament – originates at uterine horns in parametrium. Passes inguinal canal and
ends in labia majora
o BLOOD SUPPLY – uterine arteries – from internal iliac arteries
o VENOUS DRAINAGE – uterine venous plexus – goes to internal iliac veins
o LYMPHATICS
 Fundus – lumbar nodes, external iliac nodes and superficial inguinal nodes
 Body – external iliac nodes
 Cervix – internal iliac and sacral nodes
o INNERVATION – uterovaginal nerve plexus – from inferior hypogastric plexus
 Sympathetic – inferior thoracic spinal secment (lumbar splanchnic)
 Parasympathetic – S2-S4 (pelvic splancnic)
 Visceral afferent
 Pain impulses from fundus and body – follows sympathetic retrograde fibers to
inferior thoracic and superior lumbar spinal ganglia
 Pain impulses in uterine cervix and vagina – follows parasympathetic ribers
retrograde thru pelvic splanchnic
o UTERINE/ FALLOPIAN TUBES – extend laterally from the uterine horns/ cornu, open into the
peritoneal cavity adjacent to the ovaries. (ave. 10cm). lies in mesosalpinx of the broad ligament
 Parts:
 Infundibulum – funnel- shaped distal end, opens into peritoneal cavity
o Fimbriae – finger like processes at peritoneal ends
o Ovarian fimbria – attached to superior pole of ovary
 Ampulla – widest, longest part, area of fertilization of the ovum
 Isthmus – communicates with the uterine cornu
 Intrauterine segment – opens into the uterine ostium
 BLOOD SUPPLY – anastomosing branches of uterine and ovarian arteries
  VENOUS DRAINAGE – tubal vein-> ovarian and uterine venous plexus
 LYMPHATIC DRAINAGE – lumbar lymph nodes
 INNERVATION
 ovarian plexus and uterine plexus -> T11-L1 spinal ganglia
 Parasympathetic – pelvic splanchnic S2-S4
o VAGINA –musculomembranous tube (7-9cm) extends from cervix uterine to vestibule
 Lies behind the urethra and urinary bladder, anterior to rectum and between medial
margins of levator ani muscle
 Vaginal fornix – recess formed by attachment of vagina around the cervix
 Posterior fornix – adjacent to Cul-de-sac of douglas
 MUSCLES that compress the vagina
 Pubovaginalis
 External urethral sphincter
 Urethrovaginal sphincter
 Bulbospongiosus
 BLOOD SUPPLY
 Superior – uterine artery ( from internal iliac)
 Middle – vaginal artery (from internal iliac/ uterine artery)
 Inferior – internal pudendal artery (from internal iliac artery)
 VENOUS DRAINAGE – vaginal venous plexus
 Surround the vagina within the vaginal mucosa
 Drains to uterine venous plexus then to internal iliac veins
 LYMPHATICS
 Superior – internal and external iliac nodes
 Middle – internal iliac nodes
 Inferior – sacral and common iliac nodes, superficial inguinal nodes
 INNERVATION
 Superior ¾ - visceral (uterovaginal plexus)
o Contains:
 Sympathetic – lumbar splanchnic nerves
 Parasympathetic – pelvic splanchnic nerve
 Visceral afferent nerves – S2-S4
 Lower ¼ - somatic
o Deep perineal branch of pudendal nerve – sensitive to touch and
temperature
o EXTERNAL GENETALIA
 Mons pubis – rounded, fatty prominence anterior to symphysis pubis, pubic tubrecle and
superior pubic rami. Covered with coarse pubic hairs
 Labia majora – skin folds that bound the pudendal cleft, provides protection for urethral
and vaginal openings
 Contents: smooth muscles, loose subcutaneous tissue and end of round ligament of
uterus
 Anterior commisure – anterior fusion
  Posterior commisure – posterior fusion, disappears after first vaginal birth
 Labia minora – folds of fat- free hairless skin, immediately surrounds the vaginal vestibule.
Extends from clitoris and around external urethral orifice and vaginal orifice
 Contents : spongy connective tissue, sensory nerve endings, sebaceous glands
 Clitoris – erectile organ
 Vestibule – space between labia minora
 Contents: openings of urethra, vagina, and ducts of greater and lesser vestibular
glands
 Skene’s glands – located either side of urethral meatus. Source of female
ejaculation fluid
 Perineal body – supports the posterior wall of vagina, final support of pelvic viscera, lies
between vagina and anal canal