gu anatomy and physiology and history & physical exam

GU ANATOMY AND PHYSIOLOGY

andHISTORY & PHYSICAL EXAM

KIDNEYS

• 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

• 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

• 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

• 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

• 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

• Constitutional• Head, face, eyes, ears, nose, mouth and throat• Neck• Respiratory• Cardiovascular• Gastrointestinal (Abdomen)• Lymphatic• Musculoskeletal/Extremities• Skin• Neurologic

MALE GENITOURINARY EXAM

• 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