Transcript GENITOURINARY ANATOMY AND PHYSIOLOGY

GU ANATOMY AND PHYSIOLOGY
and
HISTORY & PHYSICAL EXAM
KIDNEYS
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Two kidneys, purplish brown organs
Located below the ribs toward the back
Remove waste from the blood
Keep a stable balance of salts and other
substances
• Produce erythropoietin, aids in the formation
of red blood cells
GROSS ANATOMY
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Adrenal gland caps each kidney
Enclosed within Gerota’s fascia
Each adrenal receives three arteries
Right adrenal vein empties into the vena cava
Left terminates in the left renal vein
Lymphatic vessels drain into the lumbar lymph
nodes
HISTOLOGY
• Functioning units of the kidneys are nephrons
• Secretory portion contained in the cortex
• Excretory portion is the collecting tubule
BLOOD SUPPLY
• One renal artery, branch of the aorta
• Renal artery divides into the anterior and
posterior branches
• Renal veins are paired with the ateries
• Accessory renal vessels are common
URETERS
• Two ureters
• Narrow tubes carry urine from the kidneys to
the bladder
• Adult ureter 30 cm long
STONES
BLADDER
• Triangular-shaped, hollow organ
• Located in the lower abdomen
• Attached by ligaments to other organs and
pelvic bones
• Nerves alert when time to urinate
• Two sphincter muscles circular muscles that
keep urine from leaking
HISTOLOGY OF THE BLADDER
• Bladder is composed of transitional
epithelium
• Beneath is well-developed submucosal layer
• Detrusor muscle is made of a mixture of
smooth muscle fibers, three different layers
MALE GU ANATOMY
• Seminal vesicles lie cephalic to the prostate
• Spermatic cord extends from the internal
inguinal ring
• Epididymis connected to the testis by
numerous ducts, markedly coiled
PENIS AND MALE URETHRA
• Two corpora cavernosa and the corpus
spongiosum, contains the urethra
• Aterial supply internal pudenda arteries
• Each artery divides into a deep artery of the
penis
• Dorsal vein lies external to Buck’s fascia
• May be 15 to 23 cm in length
PROSTATE GLAND
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Fibromuscular and glandular organ
Inferior to the bladder
Weighs about 20 g
Contains the posterior urethra
Consists of 5 lobes
Glands drain into the major excretory ducts,
which open in the floor of the urethra
Digital Rectal Exam
TESTIS
• Average testicle 4X3X2 cm
• Dense covering, tunica albuginea
• Covered anteriorly and laterally by serous
tunica vaginalis
• Blood supply associated with that of the
kidneys
SCROTUM
• Beneath skin of the scrotum dartos muscle
• Three fascial layers from the abdominal wall
• Two sacs divided by septum of connective
tissue
• Helps to regulate environmental temperature
Normal Male Anatomy
Paraphimosis
An Interesting Thought:
More money is spent today on Viagra
and breast reconstruction than on
Alzheimer's research. So by the year
2040, there will be lots of elderly people
walking around with perky boobs, huge
erections, and no idea what to do with
them.
FEMALE PELVIC ANATOMY
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Ovaries
Uterine fallopian tubes
Uterus
Cervix
Urinary bladder
Ureters
Vagina
Rectum
FEMALE URETHRA
• About 4 cm long
• Lies beneath the pubic symphysis anterior to
the vagina
• Arterial supply from the vesical, vaginal, and
internal pudendal arteries
• Lymphatic drainage from the external portion
is to the inguinal and subinguinal lymph nodes
NORMAL DEVELOPMENT
OF THE GU SYSTEM
• Three embryonic kidneys
pronephros 3 weeks
mesonephros 5 weeks
metanephros 5 weeks
Nephrogenesis complete at 34 – 36 weeks
NORMAL DEVELOPMENT
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Bladder and ureter development third week
of gestation
Formation of the trigone by day 33
Urine production by 10-12 weeks gestation
Genital formation begins during the fifth week
of gestation
GU ASSESSMENT OF THE
INFANT AND CHILD
• Abdomen: pain, masses
• External genitalia: normal or abnormal
• Consider sexual abuse: must be reported
Tanner System
Balanitis
Elements of Examination
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Constitutional
Head, face, eyes, ears, nose, mouth and throat
Neck
Respiratory
Cardiovascular
Gastrointestinal (Abdomen)
Lymphatic
Musculoskeletal/Extremities
Skin
Neurologic
MALE GENITOURINARY EXAM
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Scrotum: lesions, cysts, rashes
Epididymides: size, symmetry, masses
Testes: size, symmetry, masses
Urethral meatus: size, location, lesions,
discharge
• Penis: lesions, presence or absence of
foreskin, foreskin retractibility, plague,
masses, scarring, deformities
DIGITAL RECTAL EXAM
• Prostate gland: size, symmetry, nodularity,
tenderness
• Sphincter tone, presence of hemorrhoids,
rectal masses
FEMALE GENITOURINARY EXAM
• External genitalia: general appearance, hair
distribution, lesions
• Urethral meatus: size, location, lesions,
prolapse
• Bladder: fullness, masses, tenderness
• Vagina: general appearance, estrogen effect,
discharge, lesions, pelvic support, cystocele,
rectocele
Female
• Cervix: general appearance, lesions, discharge
• Uterus: size, contour, position, mobility,
tenderness, consistency, descent or support
• Adnexa: masses, tenderness, organomegaly
• Anus, perineum