MEDU 1110

Systemic Anatomy (2014-2015)

Dr. Sam HK Poon

Room 612D, 6/F, BMSB
School of Biomedical Sciences
3943 1226 1
sampoon@cuhk.edu.hk
After this lecture, you should able to:

1) Describe the internal structure and blood supply of kidney

2) Name the blood supply and common sites of kidney stone obstruction in ureter
3) Describe internal structure and blood supply of urinary bladder
4) State the difference between male and female urethra
5) Define the region of perineum
6) Describe structure of the internal and external genitalia
7) Describe the male and female reproductive tract
8) Describe inguinal canal and spermatic cord
9) Name the muscles, erectile tissues and blood supply in external genitalia
10)Understand the peritoneal fold and pouches covering the internal genitalia in female
11) Name the major ligaments and blood supply of ovary and uterus
12) Describe the significance of perineal body in female
13) Describe what is episiotomy

1
 Pyloric orifice between Left kidney Right kidney
stomach and
duodenum 11th rib
Costal margin Jugular notch
Diaphragm

12th rib 12th rib

Psoas major
Quadratus
lumborum
Transversus abdominis

L1 (transpyloric plane)
Right
Costal margin
kidney Median arcuate ligament
Lateral arcuate
ligament
Medial arcuate ligament

Left crus

Right crus Quadratus lumborum

Psoas major

Position of Pubic symphysis

umbilicus
2
 Small intestine Costal margin

Peritoneal
Left kidney
cavity

Mesentery Muscle
Right kidney Aorta
IVC
Anterolateral abdominal
wall muscle Peritoneum
Perinephric
fat Kidney
Transversalis
fascia IVC

Renal fascia
Psoas
major
Paranephric fat

* Kidneys are retroperitoneal organs surrounded by fat

Quadratus lumborum 3
 Renal capsule (reflected) Renal cortex
Renal medulla
Renal pyramid
Renal column

Renal papilla Minor calyces

1 Major calyces
2
Renal sinus (area
3 containing fat, calyces,
Minor calyx pelvis and neurovascular
Anterior view
4 bundle)
(4 segments)
Renal pelvis
1 Major calyx Ureter
5
□ Kidneys are divided into 5 segments
4 Posterior view □ Renal column is considered as medullary extention of
(3 segments) renal cortex which separates adjacent renal pyramids 4
 Glomerulus
Afferent glomerular arteriole Peritubular capillaries
Superior segmental Interlobular artery
artery

Anterior superior Arcuate artery

segmental artery

Renal artery

Interlobar artery

Posterior segmental
artery

Anterior inferior
segmental artery
Segmental artery

Inferior segmental Vasa recta

artery Renal papilla

* The segmental arteries are end arteries (i.e. they do not form
anastomoses) that supply each segment of the kidney
5
Juxtamedullary
nephron

Cortical
nephron

6
 Bowman’s capsule
Efferent arteriole

Distal convoluted Proximal convoluted

tubule tubule
Glomerulus with capillaries
Afferent arteriole covered by podocytes

7
 Ureteric branch from :
In abdomen :
• Renal artery
• Gonadal artery
Gonadal arteries • Abdominal aorta
• Common iliac artery

In pelvic cavity :
• Internal iliac artery
and its branches

8
 Normal Hydronephrosis
(left kidney)
Ureteropelvic
junction

Mid-ureter junction
(at the site of
crossing over the
external iliac vessels)

Obstruction of the urinary tract causes :

Ureterovesical • Blocking the drainage of urine
junction • Increase of pressure inside the urinary tract
• Backward pressure on the kidney:
swollen (hydronephrosis) & dysfunction
of kidney 9
 Ureters
Trigone
Base
Superior
surface
Detrusor muscle
(Smooth muscle)

Inferolateral Internal urethral sphincter

surfaces (Smooth muscle)
Urethra

Ureters External urethral sphincter

(Skeletal muscle)
Openings of ureters

Transitional epithelium

Trigone
Urethra Internal urethral 10
orifice
 Internal iliac artery Internal iliac artery
Superior vesical arteries
(supply upper part of the
urinary bladder)

Male Female

Superior vesical arteries Vaginal artery

(supply upper part of the (supplies the lower
Inferior vesical artery
urinary bladder) part of the bladder in
(supplies the lower part
of the bladder in male) female)
11
Urinary Urinary
bladder bladder

Urethra

Urethra

Male urethra
Prostatic urethra – surrounded by prostate gland
Membranous urethra – surrounded by urogenital diaphragm
Penile urethra (spongy part of urethra) – surrounded by spongy tissue in penis
12
 Male Female

Internal urethral
sphincter
Prostatic urethra
UG diaphragm
Membranous urethra
External urethral Urethra
sphincter

Penile urethra
External urethral orifice

13
14
 Prostate gland Urinary bladder

Sigmoid colon
Prostatic urethra
Prostate gland
Pelvic diaphragm
Pelvic diaphragm (levator ani muscle) Urogenital diaphragm

* Internal genital organs are above pelvic diaphragm while external

genital organs are below pelvic diaphragm.
15
 Rectovesicle pouch Primary sex organ
(a fold of parietal peritoneum)
1) Testis

Reproductive tract
2) Epididymis
3) Ductus deferens
4) Ejaculatory ducts
5 5) Urethra

Accessory sex glands

6 6) Seminal vesicles
7) Prostate gland
8) Bulbourethral glands
4

7
8 3
2 5
1
16
 Ureter

Inferior epigastric artery

Lateral umbilical fold

Small rectovesical fold

Medial umbilical fold

Median umbilical fold

Rectovesicle pouch

Prostate gland

Urogenital diaphragm
17
 3
Ureter Primary sex organ
1) Testis
6 Reproductive tract
2) Epididymis
6 3) Ductus deferens
4 4) Ejaculatory ducts
7 5) Urethra
3 4
8 Accessory sex glands
Urogenital 5 6) Seminal vesicles
diaphragm
8 7) Prostate gland
8) Bulbourethral glands
2
1

Posterior view
18
 Urinary bladder

Internal urethral sphincter

Prostate gland Prostatic part of urethra

External urethral sphincter Perineal membrane of

urogenital diaphragm

2nd blend Bulbourethral gland and its duct

Membranous part of urethra

Penis
1st blend

Penile part of urethra

Navicular fossa

External opening of urethra 19

 Before Birth After Birth

3-month fetus 1-month after birth

Parietal peritoneum
Closed upper part
Epididymis
of processus
Testis vaginalis
Ductus deferens
Pubic symphysis Spermatic cord
Processus vaginalis
Gubernaculum Tunica vaginalis
(Lower part of processus vaginalis)
Scrotal swelling
Scrotum

8-month fetus Gubernaculum

(shorten)
Abdominal muscle wall

Inguinal canal

Processus vaginalis

Penis

20
 Parietal
peritoneum Extraperitoneal fascia
Transversalis fascia
Transversus abdominis muscle
Internal oblique muscle

External oblique muscle

Testis Processus vaginalis

Gubernaculum

Parietal peritoneum

Processus vaginalis

Internal spermatic fascia

Cremaster muscle

External spermatic
fascia 21
Gubernaculum
 Peritoneum

Blood vessels
Spermatic cord

Internal spermatic fascia

(derived from transversalis fascia)
Ductus deferens

Cremaster muscle
(derived from internal oblique muscle)
Epididymis

External spermatic fascia

(derived from aponeurosis of external oblique
muscle) Testis

Tunica vaginalis
(a distal part of processus vaginalis)
(a peritoneal sac)
Dartos muscle under scrotal skin
22
23
 Genital branch of
genitofemoral Testicular artery and
nerve pampiniform venous plexus
Cremasteric vessels Parietal peritoneum

Ductus deferens Extraperitoneal fat Inferior

Diaphragm
Artery to ductus deferens Transversalis fascia vena cava
Inferior epigastric vessels

Right suprarenal Left suprarenal vein

vein
Left renal vein

Left gonadal vein

External oblique aponeurosis Left lumbar vein

Right gonadal
Internal oblique muscle
vein
Transversus abdominis muscle Left common
iliac vein
Conjoint tendon Deep inguinal ring
External Superficial inguinal ring
oblique
aponeurosis External spermatic fascia

Cremaster muscle Ductus deferens

Internal spermatic fascia

Parietal layer of the tunica

vaginalis
Cavity of tunica vaginalis Cremaster muscle
Genital branch of
Visceral layer of tunica vaginalis genitofemoral nerve

Pampiniform
venous plexus
Testicular artery 24
 Remnant Ductus deferens
of Processus vaginalis

Head of epididymis
Straight tubule

Seminiferous tubule Efferent ductules

Rete testis

Parietal layer Body of epididymis

Tunica
vaginalis Cavity
Visceral layer

Capsule
(Tunica albuginea) Tail of epididymis

25
 Endocrine portion
Leydig cells (Interstitial cells)
Leydig cells
- Secrete male sex hormone
(testosterone)

Exocrine portion
Sertoli cells
- Mediate exchange of nutrients to
germ cells
- Form blood-testis barrier to protect
developing germ cells from
Germ cells
immunologic attack
Germ cells (spermatogenic cells)
Formation of sperm

Nucleus of
Sertoli cell

26
 Urogenital Pubic symphysis Bulbospongiosus
triangle muscle
Ischiocavernosus
muscle
Ischial
tuberosity

Superficial
transverse
perineal
Anus muscle

Anal triangle Coccyx

Perineal body
External anal
sphincter muscle
* Perineal body = fibromuscular mass at the junction among bulbospongiosus,
superficial transverse perineal and external anal sphincter muscles 27
 Erectile tissues with sponge-like venous blood
spaces separated by connective tissue
Corpora cavernosa

Three cylindrical masses of erectile tissue:

Corpus cavernosum (pl: Corpora cavernosa)
• Paired dorsal cylinders
Corpus spongiosum Glans
• Deep artery at the middle
penis
Scrotum Corpus spongiosum
• Single, ventral cylinder that houses the
penile urethra
Corpora cavernosa

Corpus spongiosum

Glans penis – expanded part of corpus spongiosum

External urethral opening

Navicular fossa of urethra

Bulb of penis
(attached part Crus of penis
of spongiosum) (attached part of corpus cavernosum)
Bulbourethral gland
Perineal membrane
28
 Superficial dorsal vein

Dorsal arteries
Dorsal nerve of penis

Tunica albuginea
Deep dorsal vein

Deep arteries
Corpus cavernosum Urethra
(irregular blood-filled spaces lined
by endothelium) Corpus spongiosum
Coronal section
29
 Common iliac artery

Internal iliac artery

External iliac artery

Internal pudendal artery

External
pudendal artery
Dorsal artery aboves
corpus cavernosum

Deep artery insides

corpus cavernosum
Posterior scrotal artery

Anterior scrotal artery

30
Internal genital organs:
- Ovary
- Uterine tube (fallopian tube)
- Uterus
- Vagina

External genital organs (Vulva):

- Clitoris
- Labia majora (Female homologue of scrotum)
- Labia minora
- Opening of vagina

31
 Ureter
Suspensory
ligament of ovary

Recto-uterine fold

Broad ligament

Round ligament
Inferior epigastric
artery

Lateral umbilical fold

Medial umbilical fold

Rectouterine pouch
Ligament of ovary (Pouch of Douglas)
Median umbilical fold

Vesicouterine pouch 32
 Suspensory Suspensory
ligament of ovary Round ligament of ovary
Ovarian
ligament ligament
of uterus

Broad ligament
of uterus

33
 Ovarian vessels

Broad ligament

Suspensory
ligament of ovary

Mesovarium

Deep inguinal ring

Round ligament of uterus

Inguinal canal
Ligament of ovary
Superficial inguinal ring

Labium majus
(pl. Labia majora) 34
Cervix

Vagina

Vestibule of vagina

35
Normal uterus is anteflexed and anteversed

36
 Anastomoses of ovarian and uterine arteries

Uterus
Common iliac
artery
Gonadal(ovarian) artery

External iliac Uterine artery

artery

Vaginal artery Vagina

Internal iliac artery

37
38
Flatten, ovoid, paired glands
– Exocrine function. Maturation and release of oocytes
– Endocrine function. Secretion of estrogen and progesterone

Ovulated oocyte by
mature follicle

Uterine tube
39
 Vestibule
Vestibule

Perineal body
Perineal body

40
 Suspensory ligament of clitoris
Ischiocavernosus muscle

Bulbospongiosus
muscle

Perineal body Superficial transverse perineal muscle

Fundiform ligament of penis

Suspensory ligament of penis

Ischiocavernosus
muscle

Bulbospongiosus
Midline raphe
muscle

Perineal body Superficial transverse perineal muscle 41

 Skin
Glans clitoris Corpora cavernosa
Crus of clitoris

Corpus spongiosum

Bulb of vestibule

Corpora
Greater vestibular gland cavernosa
(Bartholin’s gland)
Corpus spongiosum

Glans penis

External urethral orifice

Navicular fossa of urethra

Bulb of penis Crus of penis

Bulbourethral gland

42
 Obturator foramen Obturator foramen
Glans of clitoris
Body of penis
Body of clitoris

Ischial tuberosity
Vaginal orifice Ischial tuberosity
Roots of penis
Urethral orifice Perineal membrane
Roots of external Perineal membrane Glans of penis
genitalia
External urethral opening

43
 Deep Shallow

♂ ♀
Pubic angle

Pelvic outlet

♂ ♀
♂ Pelvic brim/inlet
♀ 44
 Dorsal nerve of clitoris
Bulbospongiosus
muscle
Deep branches of perineal
nerve

Posterior labial nerve

Superficial transverse
perineal muscle
Perineal nerve
Pudendal nerve

Perineal body
Inferior rectal nerve

External anal
Levator ani
sphincter muscle

The perineal body is essential for the integrity of the pelvic floor, particularly in females. Its rupture
during delivery leads to damage of pelvic floor, thus predisposing the woman to prolapse of the
uterus, rectum, or even the urinary bladder Normal Prolapse

45
The perineal body may be damaged during parturition.

To avoid injury, the opening for the passage of the fetal head may be enlarged by incising
the posterior wall of the vagina and the nearby part of the perineum (episiotomy).

Procedure includes an midline or mediolateral incisions made in the tissue between the
vaginal opening and anus.

Midline incision Mediolateral incision

46