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Anatomy Lab – Exam 2

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					                                       Anatomy Lab – Exam 2
 Anterior Abdominal Wall
 ○ Structures
        Camper‟s fascia – superficial fatty layer
    Scarpa‟s fascia – deep membranous layer
    Superficial epigastric vessels – in skin?
    Thoracoabdominal nerves – (anterior cutaneous nerves: intercostal (T7-11), subcostal (T12 innervates skin
      superior to pubic symphysis), iliohypogastric (L1 skin of pubic symphysis), ilioinguinal nerves (L1 skin of
      pubic symphysis)) and lateral cutaneous nerves (branches of the intercostal and subcostal nerves)
        External abdominal oblique muscle
           Superficial inguinal ring – an opening in the external oblique aponeurosis
           Lateral crus – forms lateral portion of superficial inguinal ring, attached to pubic tubercle
           Medial crus – forms medial portion, attached to pubic crest
           Intercrural fibers –
           Inguinal ligament – inferior border of the aponeurosis of the ext obl.
         ○ Connects anterior superior iliac spine to pubic tubercle
    Ilioinguinal nerve – emerges from inguinal canal at the superficial inguinal ring, anterior to the spermatic cord
       Supplies sensory fibers to skin on anterior surface of external genitalia and medial aspect of thigh
    Internal abdominal oblique muscle – forms intermediate layer of inguinal canal
    ilioinguinal nerve – courses through inguinal canal to emerge at superficial inguinal ring
    iliohypogastric nerve – parallel but superior to ilioinguinal
    Conjoint tendon – is medial to superficial inguinal ring. Is the aponeurosis of the int obl and trans abdo musc
    Transversus abdominis muscle – contributes to deepest layer of inguinal canal
       Tough to separate from internal oblique
    Tranversalis fascia – lines inner surface of abdominal muscles
    Boundaries of the Inguinal Canal
       Deep – deep inguinal ring
       Superficial – superficial inguinal ring
       Anterior – aponeurosis of the external oblique muscle
       Inferior (floor) – inguinal ligament and lacunar ligament
       Roof – the arching fibers of the internal oblique and transversus abdominis muscles
       Posterior – transversalis fascia, reinforced medially by the conjoint tendon
    Rectus abdominis muscle – has tendinous intersections
    Inferior epigastric vessels – just medial to site of deep inguinal ring
    Superior epigastric vessels –
    The superior and inferior epigastric vessels anastomose and they are located as they sound on the deep surface
      of the rectus abdominis
    Rectus sheath (anterior and posterior) – contains rect. abdom, superior and inferior epigastric vessels,
      pyramidalis muscle
           Arcuate line – located midway between the umbilicus and pubic symphysis
    parietal peritoneum – just deep to transversalis fascia
    Linea alba – formed by fusion of aponeuroses
    Falciform ligament - ?
    Contents of the spermatic cord (the following weren‟t on the original list)
       Ductus (Vas) deferens – hard and cord-like
       Pampiniform plexus of veins
       Artery of ductus deferens – small vessel located on the surface of ductus deferens
       Testicular artery
       lymphatics, nerves
    Spermatic fascias – cannot be separated
       Internal – derived from transversalis fascia
          Middle – derived from int. oblique muscle
          External – derived from external oblique muscle
        Tunica vaginalis – serous sac that is derived from the parietal peritoneum. The space between the two layers
         is just a potential space
          Parietal layer
          Visceral layer
        Tunica albuginea – fibrous capsule of the testis
        Seminiferous tubules
        Epididymis, Head, body, tail
        Ductus deferens
 Peritoneal Reflections, Major Vessels
  ○ Structures
     Median umbilical ligament – contains the urachus
     Medial umbilical ligament – contains the obliterated umbilical artery
     Lateral umbilical ligament – overlies the inferior epigastric vessels
     Greater omentum
     Falciform ligament – divides liver into left and right lobes and connects to anterior abdominal wall
     Lesser omentum
        Hepatogastric ligament – liver to lesser curvature of stomach
        Hepatoduodenal ligament – liver to the first part of the duodenum
          ○ Contains – bile ducts (lateral), hepatic artery proper (superficial), hepatic portal vein (deep), autonomic
             nerves, lymphatics
     Round ligament of the liver – is the obliterated umbilical vein, found on inferior free margin of falciform lig.
     Coronary ligament – connect liver to diaphragm, continuous with:
        Right, left triangular ligaments
     gastrophrenic ligament
     Gastrosplenic ligament – greater curvature of stomach to the spleen
     Splenorenal ligament – spleen to posterior abdominal wall over the left kidney (not exactly what its name
       implies!!)
     Transverse mesocolon – connects it to posterior abdominal wall
     Phrenicococolic ligament – attaches left colic flexure to the diaphragm
     Sigmoid mesocolon -
     Root of the mesentery – suspends jejunum and ileum??
     Omental foramen (epiploic foramen) – connects greater and lesser peritoneal sacs, lies posterior to
       hepatoduodenal ligament
        Boundaries (NOT ON ORIGINAL LIST)
          ○ Anterior – hepatic portal vein, hepatic artery proper, bile duct (all in the hepatoduodenal ligament)
          ○ Posterior – inferior vena cava and right crus of the diaphragm covered by parietal peritoneum
          ○ Superior – caudate lobe of the liver covered with visceral peritoneum
          ○ Inferior – first part of the duodenum covered with visceral peritoneum
     Lesser peritoneal sac (Omental bursa) – inferior and superior recess (goes behind the liver)
     Subphrenic recess - ??
     Hepatorenal pouch - ??
     Peritoneal gutters
     Stomach
        Parts – greater and lesser curvature, cardia, cardial notch, fundus, body, angular incisure, pyloric part,
          pylorus
        Borders
     Liver
        Lobes – right, left, caudate and quadrate
        Parts of liver not originally on this list
          ○ Bare area – where liver is up against diaphragm
          ○ Coronary ligament – bound the bare area
            ○ porta hepatis – fissure through which vessels, ducts, lymphatics and nerves enter the liver
                forms the horizontal bar of the H on the posterior aspect of the liver
            ○ Hepatic veins – found deep in the liver and drain into the inferior vena cava
        Hepatoduodenal ligament – liver to the first part of the duodenum
          Contains – bile ducts (lateral), hepatic artery proper (superficial), hepatic portal vein (deep), autonomic
            nerves (especially in CT around the hepatic artery proper), lymphatics (too small to dissect, but hepatic
            lymph nodes can be seen)
        Celiac Trunk →
          Celiac Trunk → Common hepatic artery → proper hepatic
            artery (in hepatoduodenal ligament) →
            ○ Right gastric artery – to lesser curvature of stomach
            ○ Right, left hepatic arteries
            ○ Cystic artery – goes to gallbladder, is a branch of the
               right hepatic artery
          Celiac Trunk → Common hepatic artery → Gastroduodenal
            artery (passes posterior to the 1st part of the duodenum) →
            ○ Right gastro-omental artery
            ○ Anterior Superior pancreaticoduodenal artery
          Celiac Trunk → Left gastric artery – follows the lesser curvature starting at top, anastomoses with right
          Celiac Trunk → Splenic artery → Left gastro-omental artery
            ○ Short gastric arteries – come off the splenic artery and supply the fundus of the stomach
        Hepatic portal vein – lies posterior to hepatic artery proper and bile duct
          Left, right portal veins – after hepatic portal vein goes into porta hepatis these veins are made
          Left, right gastric veins - ????? hepatic portal vein receives these as tributaries
        Spleen – related to ribs 9-11
          Hilum – where splenic vessels enter and leave
          Borders – stomach, left kidney, transverse colon, pancreas, diaphragm
          Surfaces
        Gallbladder, parts (neck, body, fundus)
          cystic artery
          spiral fold – fold in mucosal lining of neck that continues as the cystic duct
        Right, left hepatic ducts (which exit the porta hepatis) → Common hepatic duct → Cystic duct joins in and
         then the duct is called the → Common bile duct
 Gastrointestinal Tract
  ○ Structures
     Splenic vein – behind pancreas, receives inferior mesenteric vein
     Superior mesenteric vein – joins splenic vein to form hepatic portal vein
     Inferior mesenteric vein – ascends on the left side of the inferior mesenteric artery and joins the splenic vein
       (but sometimes joins the superior mesenteric vein)
     Small intestine, parts
        Suspensory ligament of the duodenum – arises from the right crus of the diaphragm
        root of the mesentery???
     superior mesenteric plexus of nerves – autonomics surrounding SMA
     Superior mesenteric artery – origin is posterior to neck of pancreas but anterior to uncinate process and
       duodenum
        Inferior pancreaticoduodenal artery -
        Intestinal arteries – supply arcades and vasa recta of jejunum and ileum
        Middle colic artery – supplies the transverse colon
        Right colic artery – supplies the ascending colon
        Ileocolic artery – supplies cecum and gives rise to the appendicular artery
     Inferior mesenteric artery – arises between L2/L3 posterior to the inferior duodenum
        Left colic artery – supplies the descending colon and left 1/3 of transverse colon
          ○ Anastomoses with middle colic branch
         Sigmoid arteries – 3-4 arteries that supply the sigmoid colon, they are kinda arcadey
         Superior rectal artery – supplies the proximal part of the rectum
       Large intestine, parts
         Omental appendicies (Appendices epiploicae) – small accumulations of fat covered by visceral peritoneum
         Teniae coli – three narrow bands of longitudinal muscle
         Haustra – outpouchings of the wall of the colon
       Pancreas – head (and uncinate process), neck, body, tail
       Major duodenal papilla – where main pancreatic and bile duct enter the duodenum
       Hepatopancreatic ampulla – where main pancreatic and bile duct meet
       Main pancreatic duct – inside pancreas
       posterior superior and anterior superior pancreaticoduodenal arteries – both are branches of gastroduodenal
        artery
       inferior pancreaticoduodenal artery – first branch of SMA, enters the inferior portion of the head of the
        pancreas
       veins of the pancreas feed into the hepatic portal vein
       Porta hepatis
       Hepatic veins
       Rugae (gastric folds) – in stomach and all wiggly near lateral aspect
       pyloric antrum, pyloric canal, pyloric sphincter, pyloric orifice, majore duodenal papilla, minor duodenal
        papilla, ileocecal orifice and valve
       Plicae circulares – circular folds in the duodenum
       Plicae semilunares – folds in the large intestine between adjacent haustra
 Posterior Abdominal Wall
 ○ Structures
    Left and right gonadal vessels – testicular artery and vein at the deep inguinal ring (delicate)
       They branch directly from aorta at L2
       Left testicular vein drains into the left renal vein, the right testicular vein drains into the inferior vena cava
       Ovarian vessels –
       All travel over the ureter
    Kidney
       Perirenal fat
       Renal fascia
       Renal arteries – posterior to renal veins, often divides before getting to kidney
         ○ The left is longer than the right
       Renal veins – the left renal vein drains into the inferior vena cava
         ○ Left testicular/ovarian vein and left suprarenal vein drain into the left renal vein
         ○ Right renal vein has no tributaries and drains into the inferior vena cava
       Renal pelvis – main urine collecting point leading to ureter
       Ureter – continuous with the renal pelvis, is a muscular duct
         ○ Passes posterior to the testicular/ovarian vessels
       Cross Section
         ○ Fibrous capsule -
         ○ Renal cortex – outer zone of kidney, 1/3 of its depth
         ○ Renal medulla (containing renal pyramids, columns) – inner zone
         ○ Renal papillae – apex of the renal pyramid that projects into the minor calyx
         ○ renal sinus – space within the kidney
         ○ Minor calyx – cup-like chamber that is the beginning of the extrarenal duct system
         ○ Major calyx – minor calycies join to make this and multiple major calicies join to make renal pelvis
       Suprarenal glands – endocrine glands
         ○ The right one is triangular and the left one is semilunar
       Suprarenal vessels
         ○ Superior suprarenal arteries – from the inferior phrenic artery
         ○ Middle suprarenal artery – from the aorta near the celiac trunk
         ○ Inferior suprarenal artery – from the renal artery
     Paired arteries to the abdominal wall (from the descending aorta)
       Inferior phrenic arteries -
       Lumbar arteries – they pass deep to the psoas major muscle
     note – abdominal aorta bifurcates at L4
     Common iliac arteries – supply blood to pelvis and lower limbs, branch off of the two branches of ab. aorta
     Posterior Abdominal Wall
       Psoas major muscle – lumbar vertebra → lesser trocanter
       Psoas minor muscle – absent in 40% of cases
       Iliacus muscle – iliac fossa → lesser trocanter
       Quadratus lumborum muscle – 12th rib and lumbar TP → iliolumbar ligament and iliac crest
         ○ Note – transversus abdominis lies posterior to quadratus lumborum
       Lumbar Plexus
         ○ Subcostal nerve – just below rib 12
         ○ Iliohypogastric nerve -
         ○ Ilioinguinal nerve – goes to superficial inguinal ring
         ○ Lateral femoral cutaneous nerve – supplies skin on lateral
            aspect of the thigh
         ○ Gentiofemoral nerve – motor nerve to the cremaster
            muscle and supplies a small area of skin inferior and
            medial to the inguinal ligament
         ○ Femoral nerve – in groove between the psoas major and
            iliacus muscles (and innervates them)
             Dives deep to inguinal ligament and provides motor
                and sensory branches to anterior thigh
         ○ Obturator nerve – motor and sensory innervation to medial
            thigh
         ○ Lumbosacral trunk -
       Sympathetic trunk – found on vertebral body between the crus of the diaphragm and the psoas major
         ○ Lumbar splanchnic nerves –
         ○ Rami communicantes -
     Diaphragm
       Thoracic diaphragm - central tendon, sternal part, costal part, lumbar part
         ○ Right crus – connects to bodies of L1-L3
         ○ Left crus – connects to bodies of L1 and L2
       median arcuate ligament – unpaired, bridges the anterior surface of the aorta at the aortic hiatus
       Medial arcuate ligament – bridges the anterior surface of the psoas major muscle
       Lateral arcuate ligament - bridges the anterior surface of the quadratus lumborum muscle
       Central tendon – aponeurotic center of diaphragm
       Openings in Diaphragm
         ○ Vena cava foramen – in central tendon at T8
         ○ Esophageal hiatus – an opening in right crus at T10
         ○ Aortic hiatus – behind diaphragm at T12
       right and left phrenic nerves –
       Greater sphanchnic nerve – goes through crus to enter abdominal cavity, supplies celiac ganglion and
         innervates suprarenal gland
       Celiac ganglion – found on left and right sides of celiac trunk near its origin from the aorta
 Anal Triangle, Urogenital Triangle
  ○ Structures
     Note – pelvic cavity contains the rectum, urinary bladder and internal genitalia
     Note – the perineum contains the anal canal, urethra, and external genitalia; separated from pelvic cavity by
       pelvic diaphragm
 Bone structures – iliac fossa, iliopubic eminence, arcuate line, pectineal line, pubic symphysis, pubich arch,
  ischial tuberosity, ischial spine, sacral promontory, sacrotuberous ligament, sacrospinous ligament
 Boundary of Pelvic Brim – superior margin of pubic symphysis, posterior border of pubic crest, pectineal line,
  arcuate line of the ilium, anterior border of the ala of sacrum, sacral promontory
 Boundary of the Pelvic Outlet – inferior margin of the pubic symphysis, ischiopubic ramus, ischial tuberosity,
  sacrotuberous ligament, tip of coccyx
 Anal Triangle
   Gluteus maximus muscle – has an attachment on the sacrotuberous ligament and sacrum
   Sacrotuberous ligament -
   Sacrospinous ligament – connects to iliac spine
   Greater sciatic foramen – made by sacrotuberous ligament
   Lesser sciatic foramen – made by sacrotuberous and sacrospinous ligments
   Ischioanal fossae
     ○ Lateral border is fascia of obturator internus muscle
   External anal sphincter – has three parts, subcutaneous, superficial and deep
     ○ Subcutaneous – encircles the anus, but not visible on dissection
     ○ Superficial – anchors the anus to the perineal body and coccyx
     ○ Deep – circular band fused with pelvic diaphragm
   Pudendal nerve
     ○ Inferior rectal nerve, artery and vein
     ○ Internal pudendal artery and vein
         Pudendal canal – within the fascia of the obturator internus muscle
            ○ contains the internal pudendal artery and vein and pudendal nerve
 Urogenital Triangle – Male
   Contents of superficial perineal pouch (plus arteries and nerves)
     ○ Crus of the penis – ischiocavernosus covers it
     ○ Bulb of the penis – bulbospongiosus covers it
     ○ Glans of the penis
     ○ Bulbospongiosus muscle
     ○ Ischiocavernosus muscle – attaches to the ischial tuberosity and ischiopubic ramus
     ○ Superficial transverse perineal muscle – same attachments as above; hard to find
   Perineal membrane – find a triangle of it between the three above muscles
   Corpora cavernosa – continuation of crus of penis
   Corpora spongiosum – continuation of bulb of penis
   Note – both the dorsal nerve and artery of the penis go deep to the perineal membrane before the penis
     ○ The deep dorsal vein of the penis does not accompany the other two until it gets to the penis
   Dorsal nerve of the penis – paired, most lateral
   Dorsal artery of the penis – paired, in middle of the lineup
     ○ Terminal branch of the internal pudendal artery
   Deep dorsal vein of the penis – single and in the middle
     ○ drains into the prostatic venous plexus
   Superficial dorsal vein of penis – note that this is covered by a thin layer of dartos fascia
     ○ Is the major structure outside the Buck‟s fascia
     ○ drains into superficial external pudendal vein
   Bucks fascia – very tough
   Tunica albuginea – in the penis it is kinda the outer layer of the erectile bodies (cavernosa and spongiosa)
   Posterior scrotal nerves -
   UG diaphragm -
   Perineal nerve* - review picture
 Urogenital Triangle – Female
   Contents of the Superficial Perineal Pouch (plus the nerves and vessels)
     ○ Crus of the clitoris – covered by the ischiocavernosus muscle
     ○ Bulb of the vestibule – covered by the bulbospongiosus muscle
           ○ Bulbospongiosus muscle -
           ○ Ischiocavernosus muscle -
           ○ Superficial transverse perineal muscle – difficult to find
          Perineal membrane – found between the three muscles; deep boundary for superficial perineal pouch
          Corpora cavernosa – the two of these form the body of the clitoris
          Glans of the clitoris – the fun part
          UG diaphragm -
          Dorsal nerve of the clitoris* - review picture
          Dorsal artery of the clitoris* - review picture
          Deep dorsal vein of the clitoris* - review picture
          Posterior labial nerves -
          Perineal nerve* - review picture
 Pelvic Viscera and Walls
  ○ Structures
     In the male cadaver
        Rectovescial fossa – peritoneum in between the bladder and rectum
        Paravescial fossa – peritoneum on either side of the the bladder
        Perineal membrane on cut surface – deep to the bulb of the penis
        External urethral sphincter – surrounds the membranous urethra; may be difficult to see
        Rectum – has an ampulla where it starts to bend
        Ureter -
        Bladder - parts are apex, base, fundus, neck
          ○ Note that the wall thickens in the neck to become the internal urethral sphincter
          ○ Note that the superior and some posterior parts are covered by peritoneum
        Ductus deferens – enters deep inguinal ring lateral to the inferior epigastric vessels
          ○ Passes superior and then medial to branches of the internal iliac artery
          ○ Crosses superior to the ureter
        Ampulla of the vas deferens – enlarged portion of ductus deferens
        3 parts of the urethra – prostatic, membranous and spongy
        Prostatic sinus – groove on either side of the seminal colliculus
          ○ other parts in the region – urethral crest, seminal colliculus, prostatic utricle
        Seminal vesicle – lateral to the ampulla of the ductus deferens
        Duct of the seminal vesicle – joins ductus deferens to make the ejaculatory duct
        Prostate
        Retropubic space - ???
        Pubopostratic ligament - ???
        Retrorectal space - ???
     In the female cadaver
        Rectouterine pouch – between rectum and uterus
        Vesiculouterine pouch – between bladder and uterus
        Retrorectal space - ???
        Broad ligament of the uterus (parts) – continuous with the peritoneum
          ○ Mesosalpinx – supports uterine tube
          ○ Mesovarium - ovary
          ○ Mesometrium – the main flaps
          ○ Note – the tissue enclosed between the two layers of the broad ligament is the parametrium
        Round ligament of the uterus – kind of the pivot point for the broad ligament
          ○ Passes over the pelvic brim and exits the abdominal cavity through the deep inguinal ring, inguinal canal
             and ends in the labia majorus
        Ligament of the ovary – fibrous cord within the broad ligament that connects the ovary to the uterus
        Suspensory ligament of the ovary – peritoneal fold that covers the ovarian vessels
          ○ Goes from the greater pelvis to the superior aspect of the ovary
   Things made by endopelvic fascia
     ○ Transverse cervical ligaments (Cardinal Ligaments) – cervix to lateral wall of pelvis
         Contains the uterine artery
     ○ Pubovesical ligament – extends from the pubis to the cervix
   Rectum -
   Ureter – crosses inferior to the uterine artery and superior to the vaginal artery
   Bladder -
   Uterus (parts)
     ○ Fundus – superior to the attachments of the uterine tubes
     ○ Body – between the fundus and cervix; has a vesical surface and an intestinal surface
     ○ Isthmus – narrowed portion of the body superior to the cervix
     ○ Cervix – thick, fibrous portion
     ○ Endometrium (inner) and myometrium (deeper), perimetrium (outermost covering)
   Vagina
     ○ Posterior and anterior vaginal fornix
     ○ Note that posterior fornix is in contact with the peritoneum of the rectouberine pouch
   Cervix
     ○ Cervical canal
   Uterine tube (parts)
     ○ Isthmus – narrow medial part
     ○ Ampulla – widest part
     ○ Infundibulum – the funnel at the end
     ○ Fimbriae – processes that surround the distal margin made of smooth muscle
   Ovary
 In Both Sexes
   Common iliac vessels
   Internal iliac vessels – distribute to the pelvis
     ○ Anterior division are mainly visceral, posterior division is mainly parietal
   External iliac vessels – distribute to the lower limb
   Obturator canal
   Obturator artery
   Obturator internus muscle – forms the lateral wall of the ischioanal fossa
     ○ Superior to the tendinous arch it forms lateral wall of pelvic cavity, inferior to it it forms lateral wall of
        perineum
   Urinary bladder
   Trigone of the bladder – bounded by internal urethral orifice and orifices of the ureters; smooth
   Internal urethral orifices – run obliquely
   Internal iliac vessels
     ○ Don‟t worry about the internal iliac vein
    ○
    ○ Anterior Division
         Umbilical artery – find it from the medial umbilical ligament (where it is patent) and trace it back
           ○ Superior vesical artery – branch off the umbilical artery and supply the superolateral urinary
               bladder
         Obturator artery – meets up with the obturator nerve and goes through the obturator canal
           ○ Sometimes comes off the external iliac artery
         Often Arise from Common Trunk
           ○ Inferior vesical artery (male only) – supplies the bladder, seminal vesicle and prostate
           ○ Middle rectal artery – courses medially towards the rectum
                Often arises from the inferior vesicle artery
         Often Arise from Common Trunk
           ○ Internal pudendal artery – exits pelvic cavity through the greater sciatic foramen inferior to the
               piriformis muscle
           ○ Inferior gluteal artery – exits pelvic cavity between ventral rami S2 and S3 then through the
               greater sciatic foramen inferior to the piriformis
    ○ Posterior Division
         Iliolumbar artery – ascends between the lumbosacral trunk and the obturator nerve
         Lateral sacral artery – gives rise to a superior and inferior branch and does what the name says
           ○ Inferior branch passes anterior to the sacral ventral rami
         Superior gluteal artery – exits pelvic cavity between the lumbosacral trunk and ventral ramus of S1
   prostatic venous plexus, vesical venous plexus and rectal venous plexus all drain into internal iliac vein
   Anal columns – contain branches of the superior rectal artery and vein
   Anal values – folds of mucosa that collect mucous
   Pectinate line – irregular line found at base of all the anal valves
   internal and external anal sphincter – don‟t need to find
   Piriformis
   Note – most of the nerves are behind the
    rectum
   Lumbosacral trunk – ventral rami of L4-
    L5 which join the sacral plexus
   Sacral plexus (Roots of) – S1-S4
   Pudendal nerve – formed by portions of
    ventral rami of S2-S4
    ○ Exits pelvis passing inferior to
        piriformis muscle
   Pelvic splanchnic nerves – formed by
    portions of ventral rami of S2-S4, but stay
    in the pelvis to innervate organs
          ○ Made of preganglionic parasympathetics
         Sacral sympathetic chain – made of paravertebral ganglia
          ○ Sympathetic trunk – what links the paravertebral ganglia?
          ○ Gray rami communicans – connect sympathetic ganglia to the sacral ventral rami to go to lower limb
          ○ Sacral splanchnic nerves – connect sympathetic ganglia to the inferior hypogastric plexus
         Pelvic diaphragm (3 parts)




           ○
           ○ Puborectalis muscle – forms lateral boundary of UG diaphragm
           ○ Pubococcygeus muscle – body of pubis to coccyx
           ○ Iliococcygeus muscle – tendinous arch to coccyx
 Gluteal Region and Posterior Thigh
  ○ Structures
     Muscles
        Gluteus maximus – distal attachment is the iliotibial tract and the gluteal tuberosity of femur
          ○ The only nerve supply to it is the inferior gluteal nerve (blood from inferior and superior gluteal arteries)
        Things that Insert on the Greater Trochanter
          ○ Gluteus medius – inferior border is kinda uniform with piriformis
          ○ Gluteus minimus – almost the same thing as gluteus minimus, but the superior gluteal nerve runs
             between them
          ○ Piriformis – just inferior to gluteus medius
          ○ Superior gemellus – superior to obturator internus
          ○ Obturator internus – exits pelvis and becomes tendinous; can be obscured by gemellus muscles
          ○ Inferior gemellus – inferior to obturator internus
          ○ Obturator externus – in medial compartment? Not dissected?
        Quadratus femoris – inferior to inferior gemellus
          ○ Inserts on the intertrochanteric crest of femur
        Tensor fascia lata – within the fascia lata inferior to the ASIS and inserts on the iliotibial tract
          ○ Very lateral
        Posterior Thigh
          ○ All except short head of biceps femoris originate on ischial tuberosity
          ○ Biceps femoris – lateral
              Long Head – originates on ischial tuberosity and tendon
                inserts on head of fibula
              Short Head – origin – linea aspira and inserts with the
                long head
          ○ Semitendinosus – medial to biceps femoris
              long cordlike tendon that inserts on medial tibia
          ○ Semimembranous – Medial to semitendinosus
              Inserts on medial chondyle of tibia
       ○ Hamstring portion (adductor magnus) – is deep to the others and is only the med?ia?l mo?st fibers of
          adductor magnus
           Forms deep boundary of posterior compartment
    Arteries
      Superior gluteal – comes out superior to piriformis; runs in between gluteus maximus and gluteus minimus
      Inferior gluteal – comes out inferior to piriformis; deep to gluteus maximus
       ○ Supplies things inferior to piriformis
      Internal pudendal –
      Perforating brs of profunda femoris –
    Nerves
      Posterior cutaneous nerve of thigh – comes out inferior to piriformis; runs on medial side of sciatic
      Superior gluteal – comes out superior to piriformis; runs in between gluteus maximus and gluteus minimus
      Inferior gluteal – comes out inferior to piriformis; deep to gluteus maximus and is only nerve supply for it
      Sciatic – comes out inferior to piriformis; fascia contains the tibial and common fibular divisions
       ○ Travels deep to biceps femoris
      Pudendal – comes out inferior to piriformis; is the most medial and goes to anus and perineum
 Anterior and Medial Thigh
 ○ Structures
    Great saphenous vein – goes through saphenous opening into femoral vein; drains medial limb
    Femoral Triangle
       Boundaries
         ○ Inguinal ligament, sartorius muscle, adductor longus muscle
         ○ Base – inguinal ligament
       Contents – femoral nerve (and its branches), femoral artery (and some branches), femoral vein (part of
         great saphenous vein), femoral sheath (covers femoral vessels and extension of the transversalis fascia)
       Position – lateral → nerve, artery, vein, lymphatics → medial
         ○ „NAVL‟ – „navel‟
       Femoral Sheath – covers femoral artery and vein and the lymphatics
         ○ The covering for the lymphatics is also called the femoral canal
    Muscles and associated structures
       Iliopsoas – inserts on lesser trochanter
       Pectineus – basically runs with adductor longus?
       Sartorius – runs from ASIS (on lateral side) to medial proximal tibia
       Adductor longus – medial border of femoral triangle
       Adductor canal – begins at the apex of the femoral triangle follows deep to the sartorius muscle and ends at
         the adductor hiatus (opening of adductor magnus on medial side just above knee)
         ○ Contents – femoral artery and vein
       Tensor fascia lata –
       Iliotibial tract –
       Quadriceps: – all parts unite to form the quadriceps femoris tendon to attach to tibial tuberosity
         ○ Rectus femoris – middlemost quad
             Origin – ASIS (only one to originate on hip, thus crosses hip and knee)
         ○ Vastus lateralis – on lateral side
         ○ Vastus medialis – on medial side
         ○ Vastus intermedius – between vastus medialis and lateralis, behind rectus femoris
         ○ Note – descending branch of lateral circumflex femoral artery is between rectus femoris and vastus
            intermedius
       Patellar tendon – from patella to tibial tuberosity
       Medial Compartment of Thigh
         ○ Adductor longus – see above
         ○ Pectineus – innervated by femoral (the exception) and sometimes obturator
         ○ Gracilis – medial most muscle
        ○ Adductor brevis – deep to adductor longus and pectineus
        ○ Adductor magnus – deep to adductor brevis and adductor longus
            Adductor hiatus – see above
    Arteries
      Femoral – goes distally between sartorius and adductor longus muscles
        ○ Branches of Femoral that originate in the femoral triangle
            Profunda femoris – goes behind adductor longus; supplies medial and posterior compartments
              ○ Lateral femoral circumflex – has multiple branches, but the most important one is the descending
                branch
              ○ Medial femoral circumflex – goes posterior and supplies head and neck of femur
                 Goes between pectineus and iliopsoas
            Perforating branches of profunda femoris – go through the lateral aspect of adductor magnus
        ○ Note – when femoral exits the adductor hiatus, it becomes the popliteal artery
    Nerves
      Femoral – becomes a bunch of branches (for anterior compartment) in the femoral triangle
        ○ Numerous muscular branches of femoral – a bunch of branches for the anterior compartment
            Innervates entire anterior compartment
        ○ Saphenous br. of femoral nerve – the longest and most medial branch of the femoral nerve
            Cutaneous to medial side of leg, ankle and foot (not the thigh)
        ○ Nerve to vastus medialis – very long as well
      Obturator – supplies the medial compartment
 Foot
 ○ Structures
    Popliteal fossa, leg, dorsum of foot
       Borders of the Popliteal Fossa
         ○ Superolateral – biceps femoris
         ○ Superomedial – semitendinosus and semimembranosus muscles
         ○ Inferolateral and inferomedial – the two heads of the gastrocnemius muscle
         ○ Posterior – skin and deep popliteal fascia
         ○ Anterior – popliteal surface of femur, capsule of knee joint and popliteus muscle
       Contents of Popliteal Fossa
         ○ Tibial and common fibular nerves split out of the sciatic nerve
         ○ Popliteal vein and artery
         ○ Superior genicular arteries
         ○ Belly of plantaris muscle
       Bones of Foot
       Muscles of popliteal fossa
         ○ Gastrocnemius – femoral condyles to the
            calcaneal tendon
         ○ Semitendinous -
         ○ Semimembranosus -
         ○ Biceps femoris -
         ○ Popliteus – forms part of border of popliteal
            fossa
             Lateral condyle of femur to posterior
               surface of proximal tibia
             Unlocks the extended knee
         ○ Plantaris – see below
       Muscles of ant. leg, dorsum of foot
         ○ Tibialis anterior – superficial and
            medialmost in the anterior compartment
             Inserts on 1st cuneiform bone and base of the 1st metatarsal bone
         ○ Extensor hallucis longus – just lateral and a deep to tibialis anterior and extensor digitorum longus
        Inserts on base of distal phalanx of the great toe
    ○ Extensor digitorum longus – lateral and deep to tibialis anterior
        Inserts on middle and distal phalanges of the lateral four toes
        Note – each tendon forms an extenson expansion
    ○ Peroneus (fibularis) tertius –
        Inserts on dorsal surface of the shaft of the 5th metatarsal
   Muscles of lateral compartment
    ○ Peroneus (fibularis) longus – has a longer tendon than brevis
        Connects to plantar surface of the medial cuneiform and 1st metatarsal bones
    ○ Peroneus (fibularis) brevis – the muscle is deep to fibularis longus, but when both tendons bend
       around the lateral malleolus the tendon for brevis is more anterior
        Connects to tuberosity of 5th metatarsal bone
   Muscles of posterior leg
    ○ Gastrocnemius – femoral condyles to the calcaneal tendon
    ○ Soleus – deep to the gastrocnemius
        Soleal line of tibia and head to fibular to calcaneal tendon
    ○ Plantaris – the muscle part lies in the popliteal fossa, just medial to the lateral head of gastrocnemius
        Becomes tendinous and goes underneath then medial to gastrocnemius to join with the calcaneal
          tendon
    ○ Flexor hallucis longus – lateral to tibialis posterior; becomes tendinous and goes medial
        Inferior 2/3 of fibula and interosseous membrane to base of distal phalanx of great toe
    ○ Flexor digitorum longus – on medial side; tendon stays medial
        Tibia to distal phalanges of the lateral four toes
    ○ Tibialis posterior – very deep; tendon courses medially
        tibia, fibula and interosseous membrane to plantar surfaces of tarsal bones
   Arteries
    ○ Popliteal – go through popliteal fossa and stay deep
        Bifurcates into the anterior tibial and posterior tibial arteries
        Anterior tibial – goes between extensor digitorum longus and tibialis anterior
          ○ lies directly on the anterior surface of the interosseous membrane
          ○ Becomes the dorsalis bedis artery after it crosses the ankle joint
        Posterior tibial – follows the course of the tibial nerve
          ○ Fibular (Peroneal) – arises from posterior tibial artery about 2-3 cm distal to the inferior border
             of the popliteus muscle
              Runs between tibialis posterior and flexor hallucis longus
              Supplies lateral compartment and lateral side of posterior compartment
                 Perforating branch of fibular artery – branches just above ankle joint and perforates
                   interosseus membrane to anastomose with anterior tibial artery
    ○ Genicular arteries – branch off of the popliteal artery
        Superior genicular arteries (medial and lateral) – branch off popliteal artery above the knee in the
          popliteal fossa
        Inferior genicular arteries (medial and lateral) – branch off below the knee
          ○ Are deep to the gastrocnemius
    ○ Dorsalis pedis
   Nerves
    ○ Common fibular (peroneal) – goes superficial and lateral at popliteal fossa and goes parallel to biceps
       femoris tendon for a bit
        Superificial fibular (peroneal) – innervates the muscles of the lateral compartment
          ○ Is also the primary cutaneous nerve to the dorsum of the foot
          ○ Gives off dorsal digital branches
        Deep fibular (peroneal) – innervates the muscles of the anterior compartment and dorsum of foot
          ○ Follows the anterior tibial artery below the knee
    ○ Tibial – passes deep to the plantaris and gastrocnemius muscles at inferior border of popliteal fossa
        Then passes deep to soleus muscle
               In ankle is between the tendons of the flexor digitorum longs and flexor hallucis longs muscles deep
                 to the flexor retinaculum
         “Tom Dick ANd Harry” – Tibialis posterior, flexor Digitorum longus, posterior tibial Artery, tibial Nerve,
           flexor Hallucis longus
           ○ the order of everything from anterior to posterior
       Plantar foot
         Muscles of the plantar foot
                        Origin                 Insertion               Action                   Innervation
Flexor digitorum brevis   -Calcaneal tuberosity     -middle phalanges of the       Flexes lateral 4 toes
                          -Plantar aponeurosis      lateral 4 toes
Abductor hallucis         -medial calcaneal         -medial base of proximal       -Abducts great toe
                          tuberosity                phalanx of great toe
                          -plantar aponeurosis
Abductor digiti minimi    -lateral calcaneal        -lateral base of proximal      -abducts the 5th toe
                          tuberosity                phalanx of 5th toe
                          -plantar aponeurosis
Quadratus Plantar         -calcaneus                -tendon of flexor              -flexes lateral 4 toes
                                                    digitorum longus               (assists FDL)
Lumbricals                -arise from tendons of    -extensor expansions of
                          flexor digitorum longus   the lateral 4 toes
Flexor Hallucis Brevis    -1st metatarsal           -base of proximal phalanx      -flexes great toe
                          -cuboid                   of great toe
                          -3rd cuneiform
Adductor Hallucis                                   -lateral side of the base of   -adducts the great toe
                                                    the proximal phalanx of
                                                    great toe
Flexor Digiti Minimi      -base of 5th metatarsal   -base of proximal phalanx      -flexes 5th toe
                                                    of 5th toe
           ○ First Layer of Sole
                Flexor digitorum brevis -
                Abductor hallucis – on medial side of flexor digitorum brevis
                Abductor digiti minimi –
           ○ Second Layer of Sole
                Quadratus plantar – deep to flexor digitorum brevis
                4 Tendons of flexor digitorum longus – pass through the tendons of the flexor digitorum brevis
                Lumbricals – arise from flexor digitorum longus
           ○ Third Layer of Sole
                Flexor hallucis brevis – has a medial and lateral head each with their own tendon containing a
                  sesamoid bone
                Tendon of flexor hallucis longus – lies between the two sesamoid bones of flexor hallucis brevis
                Adductor hallucis – has a transverse head and an oblique head
                Flexor digiti minimi –
           ○ Fourth Layer of Sole
                interosseous muscles – DAB and PAD still apply
                fibularis longus tendon
                tibialis posterior tendon
                flexor hallucis longus tendon – sustentaculum tali changes direction of this tendon
         Arteries
           ○ Medial and lateral plantar – in second layer of sole
           ○ Plantar arterial arch – at level of the base of the metatarsal bones
                Passes deep to the oblique head of the adductor hallucis
         Nerves
           ○ Medial and lateral plantar – in second layer of sole
                common and plantar digital nerves – lie between tendons of FDB, AbdH, AbdDM
       Stuff in book, not on list
         extensor digitorum brevis muscle, extensor hallucis brevis muscle, arcuate artery, dorsal metatarsal
           arteries, lateral tarsal artery, deep plantar artery, deep fibular nerve, dorsal digital branches
                                                   Histology - Exam 2
 Digestive System 1
  ○ Objectives
     Define and/or describe the major characteristics and functions of : mucosa (epithelium, lamina propria, muscularis mucosae),
      submucosa, muscularis externa, and adventitia or serosa.
     Define and/or describe Meissner's submucosal plexus and Auerbach's myenteric plexus.
     Explain how the structure of the esophagus fits the general pattern of the digestive tract.
     Describe the major distinguishing characteristics of the esophagus and of its subregions. Be able to identify the three regions of the
      esophagus.
     Describe and identify the four major layers of the stomach.
     Describe the structure of gastric pits (foveolae) and gastric glands including the isthmus, neck and base regions.
     Describe the epithelial component of the gastric mucosa with regards to the cell types and their characteristics (surface mucous cells,
      mucous neck cells, parietal cells, and zymogenic cells).
     Describe the three major types of mucosae found within the stomach (cardiac, fundic, and pyloric) based upon the morphology and
      composition of the gastric glands.
     Describe the location of the cells that provide for the renewal of gastric mucosal cells.
     Define and/or describe an enteroendocrine cell.
     Describe the modifications of the gastric muscularis externa that are not usually found in other regions of the digestive tract.
     Name the subregions of the small and large intestines.
     Describe the four major layers of the digestive tract and the subcomponents of each.
     Define, describe, and identify examples of: plicae circulares, villi, and microvilli.
     Compare and contrast the mucosal surface of the stomach, the small intestine, and the large intestine.
     Describe the structure of an intestinal gland (crypt of Lieberkuhn).
     Describe and be able to identify appropriate examples of absorptive columnar cells, goblet (mucous) cells, enteroendocrine cells,
      Paneth cells, and crypt base columnar cells.
     What is the location of the cells responsible for the epithelial renewal for the intestinal tract?
     Describe and identify Brunner's duodenal glands.
     Identify the three major regions of the small intestine based upon microanatomical characteristics.
     Describe the changes that take place in the epithelium in the transition from the rectum to anus.
     Describe the innervation of the intestinal tract.
  ○
 Digestive System 2
  ○ Objectives
     List the functions of the liver.
     Identify the components of the "portal triad." Identify what the function is of each component.
     Describe the three major models of liver organization including; the classic liver lobule, portal lobule and liver acinus.
     Describe the path of blood flow and bile flow in the liver.
     Describe the organization of sinusoids including the contribution of Kupffer cells and endothelial cells. Describe the contents of the
      perisinusoidal space.
     Describe the function of the bile canaliculi.
     Identify the constituent cells of the liver and be able to list their functions
     Describe the ultrastructure of the hepatocyte.
     Identify the endocrine and exocrine portions of the pancreas, their constituent cells and their function.
     Describe the organization of the secretory portion of the exocrine pancreas and the secretory products its constituent cells.
     Describe the histological organization of the gall bladder. Correlate the function to the morphology of the organ.
  ○ SEE THE DEMOS AND BOOK FOR PICTURES
  ○ Liver
     Made of hepatic cord cells and hepatic sinusoids
     Pig liver lobules are well defined by CT
     Human Hepatic Lobule – a 3D structure with lots of sinusoids and cords radiating from a central vein.
        Central Vein - simple squamous epithelium (just like other vessels)
        Hepatic Triads – 2-6 mark the boundary of the lobule and contain
          ○ Bile Duct – cuboidal cells
              Characteristic – round nuclei very prominent and have „string of pearls‟ appearance
          ○ Hepatic Artery – has circular smooth muscle
          ○ Portal Vein – much larger
        Hepatic Cords – hepatocytes in single file
        Blood Flow – portal vein → central vein → hepatic vein → inferior vena cava
      Bile Canaliculi – appear in between hepatocytes of hepatic cords and run at right angles to cords
      Sinusoids – have two cell types
       ○ Endothelial Cells – have darkly stained elongated nuclei and form sinusoidal wall
       ○ Von Kupffer Cells – have a round nucleus and a cell body that bulges into the sinusoid
           In pictures with staining for phagocytosis you can clearly see Kupffer cells
             ○ Here they look like cylindrical/long/odd shaped blue cells
      Space of Disse – best seen at EM level, is the space between sinusoids and hepatic cords
       ○ Kinda tricky




       ○
   Remember the different classifications of liver units
   Liver Reticulum
     Reticular Fibers – black type III collagen fibers (with special stain) weave around hepatocytes and support
       central veins, sinusoids and bile ducts




    
○ Gall Bladder
    Numerous folds/plicae mucasa and crypts but no glands, lymphoid tissue or goblet cells
    Diagnostic – the folds can form diverticula (closed pockets of epithelium)
    Comparison to GI tract – wall is thinner, adventitial layer is thicker
    Layers
      Mucosa
        ○ Epithelium - simple columnar
        ○ Lamina Propria
      Muscularis Externa – mixture of longitudinal, circular and oblique fibers hard to distinguish
 ○ Pancreas
    Exocrine Portion
      Divided into lobules (by CT which is green with stain) and have serous acinar cells
      Serous Acinar Cells – have large round nuclei
        ○ Fibroblasts and capillaries in between alveoli
      Centroacinar Cells - project into the lumen of the alveoli and are lighter staining
        ○ diagnostic for pancreas




        ○
       Excretory Ducts – light staining, cuboidal epithelium with prominent round nuclei that look like „chain of
        pearls‟
     Endocrine Portion
       Islets of Langerhans – endocrine portion; round cell clusters
     How to differentiate pancreas from parotid gland
       Alveoli are more clearly divided in parotid
       There are numerous intralobular striated ducts in the parotid
       The pancreas has islets of langerhans
       The pancreas contains centroacinar cells
 Urinary System
 ○ Objectives
    Identify the organs of the urinary system and relate their functions to their morphology.
    Relate the structural and functional differences between unilobar versus multi-lobar and multilobular kidneys.
    Identify the different components of the nephron and the different types of nephrons. Relate the different structures and their
     components to their specific function.
    Trace a RBC through the kidney circulation and relate the structure of the different vessels to their function of the kidney.
    Identify the structures making up the blood-urine filtration barrier.
    Relate the formation of urine to the various structures found in the kidney.
    Trace the path of urine from its formation to its release from the body.
 ○ Note – lower mammals have a unilobar and multilobular kidney (thus no renal columns or minor calyces)
 ○ Note – human kidney is multilobar and multilobular
 ○ Kidney
    Low Magnification
      Capsule – dense irregular CT; areolar and adipose tissue may be present outside capsule
      Cortex – darker staining
        ○ Cortical Labyrinth – dark staining with convoluted tubules and renal corpuscles
             Renal Corpuscles – small round islands of densly stained material and clear space around it
          Convoluted Tubules – coiled tubules have thicker walls and stain darker
          Identify cortical vs juxtamedullary nephrons based on location
      ○ Medullary Rays – lighter staining medullary material extending into cortex
          Contain straight portions of cortical nephrons and some collecting ducts
          Have thin walls and reduced cytoplasm and are thus lighter staining
     Medulla – lighter staining and extend into cortex
      ○ renal columns (although no renal columns can be seen because they don‟t exist in smaller mammals
         and aren‟t on the human slide)
      ○ Renal Pyramids – thin walled tubules and straight portions of nephrons and collecting ducts
      ○ Renal Papilla – where they drain tino calyces
     Renal Lobe – renal pyramid and overlying cortex
     Renal Lobule/Cortical Lobule – area of cortex in the cortex containing a medullary ray and associated
      labyrinth material
      ○ Thus area between two medullary rays is a renal lobule
     Major and Minor Calyces and Renal Pelvis – kinda hard to see on slides




    ○
 Nephron
   Bowman’s Capsule – round island with gap around it
    ○ Parietal Layer of Bowman’s Capsule – layer of simple squamous epithelium around periphery
    ○ Bowman’s Space –
    ○ Visceral Layer of Bowman’s Capsule - only seen at EM level
         Have Podocytes that surround endothelial cells of capillaries
    ○ Glomerulus – tuft of coild capillaries
    ○ Mesangial Cells – tough to find
    ○ Vascular Pole – where the glomerulus fuses to the side of the renal corpuscle
         afferent and efferent arterioles (indistinguishable) connect here
    ○ Urinary Pole – opposite end where the proximal convoluted tubule originates
    ○ Note – look for RBCs and the proximal convoluted tubule when distinguishing the poles
   Proximal Convoluted Tubules – small indistinct lumen
    ○ Single layer of tall cuboidal epithelial cells that stain red
    ○ Brush border (microvilli) makes the lumen indistinct – diagnostic
    ○ Basal Striations – infoldings of plasmalemma associated with mitochondria to increase active transport
         Mitochondria require different darker staining? And the basal striations are just clumps of mitochond.
   Distal Convoluted Tubules - large distinct lumen but same size tubule (thinner tubule wall)
    ○ low cuboidal epithelium
    ○ Luminal surface is more distinct (no brush border)
    ○ Basal striations are less distinct
   Juxtaglomerular Apparatus – where distal convoluted tuble touches renal corpuscle
    ○ Macula Densa – part of DCT that touches the glomerulus
         nuclei of tubule are tightly packed together in straight line
    ○ Juxtaglomerular Cells – part of afferent arteriole
         dense mass of tightly packed small nuclei
    ○ Extraglomerular Mesangial Cells – difficult to distinguish from JG cells
 Cortico-Medullary Junction
       Arcuate Arteries (muscular) and Arcuate Veins (medium sized) – run along the long, horizontal part of
         renal pyramid (marks junction of medulla and cortex)
         ○ Not in between two medulallary rays
       Interlobular arterties and veins – give off afferent arterioles and are perpendicular to arcuates and in the
         cortex
         ○ In between two medullary rays
    Medulla
       Arrangement
         ○ Outer Medulla – contains thick and thin segments, collecting ducts and vasa rectae
         ○ Inner Medulla – contains lots of thick sements (no thick segments) and lots of collecting ducts. Also
            contains vasa rectae and loops of Henle
       Thick Segment of Loop of Henle – descending segment is more similar to PCT and ascending segment is
         more similar to DCT
         ○ Kind of hard to differentiate, but in general are more oval and cell borders are more distinct
       Thin Segment of Loop of Henle – narrow channel lined by simple squamous epithelium
         ○ In between collecting ducts and thick segments
       Vasa Rectae – very similar to thin segments, except they have RBCs in lumen
       Collecting Ducts – a little larger than the thick segment.
         ○ Epithelium goes from low cuboidal to tall cuboidal as you get towards papillary ducts
         ○ Duct of Bellini – round nuclei and a little lighter staining
         ○ Diagnostic – can see distinct cell borders between adjacent cells of the duct
       Area Cribrosa – looks like a sieve on tip of a papilla
       Calyces – various epithelia
 ○ Ureter
    Diagnostic - start shaped lumen with transitional epithelium
    Lamina propria merges into submucosa, because there is no muscularis mucosa
    Muscularis layer contains inner longitudinal and outer circular layers (opposite normal)
       Near the bladder an outer longitudinal layer is added
    Tunica adventia also present
    All layers except epithelium will have some nerves and BVs
 ○ Urinary Bladder
    Nondistended
       Nondistended Transitional Epithelium – 6-8 layers and large dome-shaped cells on free surface covering
         multiple cells underneath
         ○ Thinner than stratified squamous epithelium
       No muscularis mucosae
       Muscularis layer has inner longitudinal, middle circular and outer longitudinal but are indistinguishable
       Tunica adventitia has adipocytes, BVs and nerves
    Disteneded
       Distended Transitional Epithelium – 3-5 layers thick, with surface cells more stretched out
       Inner muscular layer looks circular
       Everything just looks thinner
 ○ Urethra
    Female
       Epithelium - Crescent shaped lumen
         ○ From bladder to end it transitions from – transitional → pseudostratified columnar → stratified
            squamous mucosal
       Muscularis
         ○ Inner longitudinal and outer circular smooth muscle, with skeletal muscle forming external sphincter
            near orifice
    Male
       Penile urethra is stratified columnar with mucous cells
 Female Reproductive System
 ○ Objectives
    Identify the various organs of the female reproductive tract and relate the structure to its function.
    Identify the various morphological components of each of the organs and how their structure relates to their function.
    Relate how the various hormones control the function of the organs and their structural components during the menstrual cycle.
    Relate the structure of the cervical-vaginal junction to the formation of cancer.
    Describe the development and fate of the corpus luteum and how it changes when fertilization occurs. Include the theca lutein and
     granulosa lutein cells, their origin, and sites of hormonal production.
    Name the four parts of the uterine tube and distinguish their histological differences.
    Describe the layers of the uterus. Identify the main phases of the menstrual cycle.
    Describe the morphological changes in the endometrium during each phase of the menstrual cycle. Indicate the principal hormones
     responsible for the morphology of each phase and from where they arise.
    Describe the specific type of epithelium and the shape of glands found in the uterine cervix, as well as the epithelial lining of the
     vagina.
    Identify the mammary gland in both the active and inactive state by its morphology. Be able to relate the structural changes to the
     function.
    Identify the components of the breast. Explain how the histology of the breast changes from the resting state to the active state
     (lactation)
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 Male Reproductive System
 ○ Objectives
    Identify the various organs of the male reproductive tract and relate the organ‟s structure to its function.
    Identify the morphological components of each organ and relate it to the organ‟s function.
    Relate how hormones and secretions control the morphology and function of the male reproductive tract.
    Identify the blood testis barrier and its function.
    Relate the blood circulation to the structure of the penis in the flaccid and erect state.
    Relate the process of ejaculation to the structure of the male reproductive tract.
    Trace the structural changes and the course of sex cells from their development in the seminiferous epithelium until expulsion from
     the body.
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