Endocrine System and Reproductive § Anterior Lobe (Adenohypophysis)
System v Responds to hormones from the
hypothalamus through the H-h portal system (Hypothalamus – Quick Trans by: Alyssa Balt hypophyseal portal system) Lecture by: Doc DJ v Hormones – ACTH, FSH, LH, Date: January 29, 2018 Prolactin, GH and TSH
TEXT ONLY | NO FIGURES | PPT AND SIDE NOTES § Posterior Lobe (Neurohypophysis) Endocrine System v DOES NOT produce hormones;; § The Endocrine System is a collection of v Stores hormone from the glands that produce hormones directly hypothalamus – ADH and Oxytocin into the circulatory system to be carried v Transmitted through nerve impulse. to distant target organs. § Function: regulate metabolism, growth Hypothalamic Connections and development, tissue function, sexual function, reproduction, sleep and Hypothalamo – hypophysial Portal System mood. § Blood vessels connecting the anterior lobe of pituitary gland to the Pineal Gland hypothalamus. This transmits the § “Epiphysis Cerebri” releasing factors to the anterior lobe. § The pineal gland is pinecone-shaped organ located posterior to the 3rd Hypothalamo – hypophysial Nerve Tract ventricle and is overhanging the § Connection of the posterior lobe of midbrain. pituitary to the supraoptic and § It produces, Melatonin, a serotonin- paraventricular nuclei of the derived hormone which plays a role in hypothalamus. regulating sleep patterns (circadian § Hormones Vasopressin and Oxytocin rhythm). are released at the axon terminals in the posterior lobe of pituitary. § Melatonin secretion is decreased ¯
during daytime, among elderly and Note: The body of sphenoid has depression, insomniacs Sella Turcica. Sella Turcica is covered by
reflection of meningeal matter, Diaphragm Note: Pineal gland has sexual function (activity Sellae. of the gonads).
Blood Supply and Venous Drainage of the Pituitary Gland Pituitary Gland § A tiny organ at the base of the brain, § Superior and Inferior Hypophyseal weighs about 0.5 gms. Arteries from the Internal Carotid Artery § Attached to the hypothalamus by § Veins drain into the Intercavernous infundibulum (nerve tract). Sinus o Infundibulum / Infundibular Stalk
/ Pituitary stalk Thyroid Gland § It is called the “master gland” because § Encapsulated bilobed gland it produces many hormones that direct § Enclosed by the pretracheal fascia certain processes/stimulating other outside the capsule organs to produce other hormones. Note: Pretracheal Fascia is the layer that moves § It is controlled in large part by the when swallowing. It is attached to the cricoid hypothalamus. cartilage.
§ An isthmus connects the 2 lobes (L and Note: Pituitary Gland is the “Master Gland” R) across the midline, in front of the 2nd because it controls the activity of stimulating – 4th tracheal rings hormones. § Weighs about 25 gms.
Lobes of Pituitary Gland Note: Thyroid Gland is smooth and usually, not Note: Maximum of 6 pairs (excess is formed in palpable. It is heavier in females. Not visible in the thorax) neck. § blood supply comes from superior and inferior thyroid arteries Blood Supply of the Thyroid Gland The blood supply of the Thyroid Gland comes from: Function of Parathyroid Glands § External Carotid – Superior § Secrete Parathormone (Parathyroid Thyroid Artery Hormone) § Thyrocervical Artery – Inferior § an osteoclastic hormone, mobilize Thyroid Artery calcium from bones, increase Note: Left Inferior Thyroid Artery and Right absorption of calcium from intestine, Inferior Thyroid Artery join before terminating to increase reabsorption of calcium in Left Innominate Veins. proximal convoluted tubules. § Arch of Aorta/Left Common Carotid/Brachiocephalic – Thymus Gland Thyroidea Ima § A bilobed organ located in the superior mediastinum directly behind the Note: Thyroidea Ima is the smallest thyroid manubrium artery and has inconsistent blood supply. § It is the primary or central lymphoid organ Function of the Thyroid Gland § Its function is production of T (thymic) § Secretion of Thyroxin (T4) and lymphocytes that are seeded to the rest Triidothyronine (T3), which increase of the lymphatic system. the metabolic activity of most cells in the body Note: Thymus gland has bone and lymphoid v Increase Oxygen consumption and origin. Heat production Thymic Hormone § Produces the hormone, § Thymosin influences the maturation Thyrocalcitonin, that lowers the blood and function of lymphocytes within the calcium level thymus and elsewhere in the body v not under the control of the pituitary but stimulated by hypercalcemia Blood Supply of Thymus Gland and suppressed by hypocalcemia § Inferior Thyroid Artery Note: If the blood calcium levels are normal, § Internal Thoracic Artery calcitonin will stop. Suprarenal Glands Note: Hypothyroidism symptoms include: feeling § Paired glands cold in hot weather, sleepy, gains weight despite § Yellowish retroperitoneal organs that lie the less food intake. The opposite of which is on the upper pole of the kidneys Hyperthyroidism. § Surrounded by Renal Fascia (Gerota’s Fascia) but are separated from the Note: Immunocompromised patients have kidney by perirenal fats. enlarged thyroid gland. o Note: In between SR glands, perirenal fats. Parathyroid Gland § weighs about 25mg Note: § located on the posterior surface of the Right SR – pyramidal in shape and is limited to thyroid gland the upper pole of the kidney;; drains IVC § usually 2 pairs, upper pair being more Left SR – crescentic;; extends to the medial constant in position at the middle part of border of the kidney;; drains in L Renal Vein. posterior surface of thyroid gland. Note: Review: What are the tributaries of Left The inferior pair is found at the lower Renal Vein? Left SR, Left Gonadal, Left border of thyroid gland. Inferior Phrenic Veins. Superior SR – derived from Inferior Phrenic prostate. Prostate is palpable during rectal Artery exam. Middle SR – direct branch of Abdominal Aorta Inferior SR – derived from Renal Artery Note: Prostate is an outpouching of the urethra about 10ft;; doughy, no greasy sensation and no Blood Supply and Venous Drainage nodules. At 60 yrs. Old, there’s hypertrophy of § Right and Left Inferior Phrenic Arteries Median lobe making urination difficult. § Middle Suprarenal Artery - The most glandular portion of § Left Inferior Adrenal prostate is Median Lobe. (à usually the affected lobe in Benign Parts of Suprarenal Glands Hyperthyroid) § Suprarenal cortex v function controlled by anterior lobe Note: Visual Malignancy is seen on Posterior of pituitary through a hormone, Lobe;; It will not have early symptoms of Adrenocorticotropic Hormone obstruction because it’s too far. Usually, once (ACTH) detected, there’s already metastatis. v Note: Glucocorticoids, Adrenal Androgens (à masculinity in Note: Prostatic Urethra – urethra traversing females) prostate;; It is the widest and most dilatable § Suprarenal Medulla portion of the entire urethra. § Secretes catecholamines, epinephrine and norepinephrine Note: Blood Supply of Prostate: Inferior Vesical Pancreas Artery – branch of Internal Iliac Artery at Parts: Anterior Division;; supplies the prostate (also, • Head base of bladder, prostate and seminal vesicles in the • Neck male;; it also gives off the artery to the vas deferens) • Body Note: • Tail Lobes
Lateral – lies on either sides of urethra;; with Blood Supply of Pancreas § Superior pancreaticoduodenal Artery glands § Inferior pancreaticoduodenal Artery Median – between urethra and ejaculatory ducts;; § Splenic Artery with glands § Superior Mesenteric Artery Posterior – behind the urethra;; with gland Anterior – lies in front of the urethra;; NO gland
(aglandular) Lymph nodes of Pancreas § Celiac Nodes Seminal Vesicles
Reproductive System • Lies at the posterior wall of Posterior surface of urinary bladder Male Reproductive Organs • NOT A RESERVOIR glandular organ;; Internal Genitalia • Made up of long tube, coiled upon itself;; § Prostate Gland coiling is permanent, can’t be stretched. § Seminal Vesicle • Secretion: § Ejaculatory Duct v added to the bulk of ejaculate and seminal fluid Note: Prostate Gland is wedge-shaped below v rich in sugar (fructose) – for motililty urinary bladder. It has 5 lobes: 2 Lateral lobes, 1 and life of sperm and nourishment Medial lobe, 1 Posterior Lobe and 1 Anterior of the spermatozoa Lobe. Prostatic Secretion: The prostate produces a thin, milky fluid containing citric acid Seminal Duct and acid phosphatase that is added to the • joined by Vas Deferens seminal fluid at the time of ejaculation. The v Vas Deferens is the distal secretion is drained into urethra (note: seminal continuation of epididymis. veins, testis and spermatozoa also drain into urethra) during ejaculation by contraction of the Ductus Deferens • Joins with duct of Seminal Vesicle § Skin of scrotum is corrugated and provided with few scattered crisp hairs. Seminal Duct + Ductus Deferens à Ejaculatory § Skin is provided with sebaceous gland Duct (secretion: less sugar) and modified sweat (apocrine) gland. § Dartos layer contains smooth muscle – Ejaculatory Duct the dartos muscle. • pierces the base of prostate, terminates in the prostatic urethra and is drained Note: Testes are housed in scrotum. into prostatic sinuses Note: Layers of Scrotum Prostatic Sinus 1. Skin • where secretion of Prostatic Gland is 2. Superficial Fascia drained 3. Spermatic Fascia a. External Spermatic Fascia Vas Deferens - Derived from the aponeurosis of the • only excretory duct of Testis external oblique muscle v Urerter is the excretory duct of b. Cremasteric Fascia kidney. - Derived from internal oblique muscle • the one cut during Vasectomy c. Internal Spermatic Fascia - Derived from Fascia Transversalis Blood Supply: Inferior Vesical Artery – branch of Internal Iliac Arery (à supplies the internal genitalia among Penis (Dorsal) males) • Anatomical position: directed upward
Urogenital Diaphragm Penis is the male organ of copulation. • below the prostate It consists of 3 erectile bodies: • contains muscles of deep transverse § 2 Corpus Cavernosa perineal embedded at pea size gland, § 1 Corpus Spongiosum Bulbourethral Gland Note: Each erectile body is surrounded by a Bulbourethral Gland tough fibrous tissue, Tunica Albuginea. • aka: Cowper’s Gland • Tunica Albuginea can expand only to a • secretion: serves as a lubricant fluid and limit;; It’s made up of cavernous sinus precedes ejaculation;; drains into Penile (finer spaces that become engorged Urethra with blood during erection but to a certain extent only limited by tunica Penile Urethra albuginea). • traverses the penis (Corpus • Filling of cavernous sinus will cause Spongiosum, specifically) erection.
• opens at the tip of the penis It consists of 3 parts of the penis: • receives the secretion of Bulbourethral § Glands Gland § Body/Shaft
§ Root of Penis Membranous Urethra
• shortest and least dilatable Erectile Structures of the Penis 1. Corpora Cavernosa External Genitalia a. Proximal parts consist of 2 § Penis tapering ends that are attached § Scrotum to the ischiopubic rami, the § Testis and Epididymis crura.;; divergent § Vas (Ductus) Deferens Note: Crura is attached to isthiopubic ramus which covers the muscle. Scrotum is a cutaneous pouch consisting of skin and dartos fascia. b. Distal ends are embedded in the aspect of Testis;; where Spermatozoa is formed). glans penis, part of the corpus The tubules open into a network of channels in spongosum. the mediastinum called the Rete Testis. Rete 2. Corpus Spongiosum Testis is conveyed to unite and form body of a. Proximal expansion is the bulb Epididymis. à Efferent Ductules connect the of penis, the distal expansion is rete testis to the upper end of the epididymis à the glans penis Epididymis (at posterolateral aspect of testis;; b. It is traversed by the penile inside Epididymis, there’s duct – ductus urethra from the bulb to the tip epipididymis, which has head, body and tail of the glans. (which is connected to Vas Deferens) à Vas
Note: Towards the end of Urethra before Deferens/Ductus Deferens à ascends to termination at its distal end, you will see a slight inguinal canal à enters pelvic cavity à expansion: Fossa Navicular – external urethral Seminal Duct à Ejaculatory Duct à Penile orifice of penile urethra;; most constricted Urethra
Note: Urethra has both Urinary and Note: Tyson’s Glands are modified sebaceous Reproductive functions. glands. Their secretion is one of the components of Smegma. Note: The root of the penis consists (a) Bulb of Penis and (b) L and R crura of the penis. Superficial Fascia of the Perineum § The Dartos Layer of Scrotum – the Parts of Penis inferior continuation of the Camper’s § Body: consist of 3 erectile bodies such Fascia of Anterior Abdominal Wall. as the 2 dorsal corpora cavernosa and 1 ventral corpus spongiosus. § In the Perineum, the superficial fascia § Root: consist of the proximal ends of loses its fats and acquires the dartos the corpora cavernosa, the crura and smooth muscle. proximal ends of corpus spongiosum, the bulb § The Dartos Muscle contraction is § Glans: the distal expansion of the responsible for the corrugation of the corpus spongiosum that contains the scrotal skin. navicular fossa and external urethral orifice. Colles’ Fascia is a superficial fascia in the perineum deep to the darto’s fascia. It is derived Penis, cross section from the Scarpa’s Fascia on the Anterior § Blood vessels and nerves Abdominal Wall. v Superficial dorsal vein: 2 dorsal bodies embedded in the superficial Note: In Perineal Cavity, arteries and nerves that fascia supply the pelvis are the Internal Pudendal Note: In uncircumcised, Superficial Dorsal Vein Artery and Internal Pudendal Nerves. is attached to ventral surface of glans. SDV is the one cut during circumcision. Erection v Deep dorsal vein and dorsal artery • Pelvic nerves and nerve are in the deep fascia. • Parasympathetic § Deep Fascia of Penis (Buck’s Fascia) v Limits the penis Ejaculation § Tunica Albuginea – a tough fibrous • Sympathetic covering of each corpus spongiosum and cavernosa;; Note: Convoluted Seminiferous Tubule Is at the Posterior aspect of testis Note: Tunica Albuginea extends into the Female Reproductive Organs substance of testis and sends out processes to Internal Genitalia “Septula Testis”, and then into a space called § Ovary “Testicular Lobule”. Within each lobule are § Uterine (Fallopian) Tube convoluted Seminiferous Tubules (at Posterior § Uterus § Upper Part of the Vagina ovum to bo be fertilized. Ovum is expelled from ovary à Menstruation (“thick cry of frustrated External Genitalia uterus”). § Mons Pubis § Labia majora and Labia minora Note: Cilia – pushes towards the uterus. § Clitoris § Bulb of Vestibule Uterus, in Layman’s Term – “Womb”, is about § Vestibule of the Vagina 7.5 to 8 cm long and is entirely a pelvic organ;; § Lower part of the Vagina From lower part of Pelvis to fundus of Uterus. § Greater Vestibular Gland (Bartholin’s Gland) Note: Uterus is bent forward (downward).
Ovary is the female homologue of the testis in § 3 main parts: male. v Fundus – above the attachment of § Releases egg every month fallopian tubes § produces the hormones: estrogen and v Body – between the fallopian tubes;; progesterone. between the body and cervix, Note: Interstitial Cell Stimulating there’s Isthmus of Uterus Hormone (or Luteinizing Hormone in (*landmark). females) v Cervix – inside the cervix: § releases the matured ovum. Opening between cervical canal and § located in the lateral pelvic wall. uterine cavity: Internal Os Opening between cervix and vagina: Note: Oviduct transports immature ovum External Os released from the ovaries. Cervix projects into vagina, so there will be recesses around the cervix. Uterine (Fallopian) Tubes § Uterine tube, paired tubes that convey Note: Cervix of a virgin – has an opening like matured ovum to the uterus. that of a little finger;; soft and smooth and like § Spermatozoa travels upward to meet that of the tip of the nose. the ovum. § Mucosal lining is provided with cilia that § Wall has 3 layers: propel the ovum/fertilized ovum towards v Epimetrium – outermost layer the uterus. v Myometrium – THICKEST layer § Has 2 openings, the abdominal os and v Endometrium – innermost layer the uterine os. Uterine Cavity is triangular and has upper 2 Parts of Uterine (Fallopian) Tubes angles, the uterine os of the fallopian tubes and § Outside the Uterus an inferior angle, the internal os, which is the v Infundibulum communication between uterine cavity and the - characterized by finger-like projections called cervical canal. “Fimbriae” v Ampulla Communications of the Uterus -Rendezvous for fertilization § Uterine Tubes (Fallopian Tubes) v Isthmus § Cervical Canal
§ Within the wall of uterus Cervix is the lower part of the uterus below the v Intramural portion isthmus. § Cervical Canal – fusiform in shape;; Note: Egg is taken to Oviduct by Fimbriae. passageway in the cervix. Oviduct transports the egg into the Uterine § Internal Os – superior opening of the Cavity. canal through which it communicates with the uterus. Note: After the release of ovum, there’s thickening of internal layer for preparation for § External Os – inferior opening of the Note: Clitoris is formed like Penis, except that it canal through which it communicates has no opening of urethra. Urethra opens at with the vagina. vestibule of vagina.
Normal Position of the Uterus Greater Vestibular Glands are the homologues § Anteflexion, uterus being bent on its of bulbo-urethral glands in male. It’s pea-sized cervix. lobulated structures at the posterior poles of the § Anteversion, uterus bent on the vagina. bulb of vestibule. Their ducts open into the vestibular fossa posterior to the vagina orifice. Vagina is the organ of copulation. It’s 7.5 to 8 It secretes mucus that lubricates the vulva. cm long. It has NO mucosal glands. It is moistened by secretion from the Cervical Gland HOMOLOGUES: of the cervix. Superiorly forms recess around the vaginal part of the cervix – the fornices. Bulb of Vestibule Bulb of Penis Ovary Testis Recesses of the Vagina Uterus Prostatic Utricle § Fornices of the vagina Bulbourethral gland Greater Vestibular v Anterior, anterior to the cervix (“Cowper’s Gland”) Gland (“Bartholin’s v Lateral, on each side of the cervix Gland) v Posterior, posterior to the cervix. Labia Minora Prepuce § The deepest among the Labia Majora Scrotum fornices Pudendal Cleft Median Raphe § The opening of the cervix is directed to Vagina Penis the posterior wall of the posterior fornix.
Mons Pubis is a conspicuous, subcutaneous fat
pad over the pubic bones and symphysis. It is CASE DISCUSSION: covered with pubic hair, largely absent in male.
A 48-year old female presented to her physician Labia Majora is a broad longitudinal fold of skin complaining of difficulty in breathing and filled with subcutaneous fat and fibrous tissue. swallowing. She was also concerned at the Its medial surface is smooth and provided with increase in size of her neck. On physical plenty of sebaceous gland. It encloses a space, examination, an irregular firm mass in an the pudendal cleft. anterior aspect of the lower neck was palpated.
The mass moved up and down during Labia Minora is a smaller fold of skin, devoid of swallowing. An ultrasound scan and needle fat on the pudendal cleft. It encloses a space, biopsy revealed the mass to be a multinodular the vestibule of the vagina. The union of the goiter. A subtotal thyroidectomy was performed. labia minora posteriorly is the frenulum of the After the procedure, the patient complained of labia or the fourchette. It’s the homologue of tingling in her hands and feet, and skin of Penis. carpopedal spasm. These symptoms
disappeared after 24 hours. Bulb of Vestibule is an oval shaped mass of
erectile tissue partly embedded in the substance 1. What is a goiter? of labia minora. They taper and are joined to 2. Why did the mass move up and down during one another toward the clitoris. It’s attached to swallowing? the undersurface of clitories by parts of 3. Why was the patient having difficulty in intermedia and commissure of the bulb. breathing and swallowing?
4. Despite only a subtotal thyroidectomy Clitoris is the homologue of Penis, but consists performed on the patient, she experienced only of 2 erectile bodies, the corpora cavernosa clitoridis. It begins as a crura of tingling sensation and carpopedal spasm. Why? clitoris attached to ischiopubic rami, uniting to 5. What is Chvostek’s sign? form the body of clitoris, connected to the 6. How can one avoid damaging the recurrent symphysis by suspensory ligament. It ends in laryngeal nerve during a thyroidectomy? a tiny glans. 7. What is the consequence of injuring the recurrent laryngeal nerve during a Neck has 3 layers: thyroidectomy? Fasciculi/Deep Cervical Fascia § Pre – vertebral layer § Pre – tracheal layer Mass: o Plasters the structure • “firm” – hard § Superficial Deep Cervical Layer • “cystic” – soft “Iatrogenic” – caused by the treatment itself;; Thyroid Scan – to determine if mass s hot or § Recurrent Laryngeal Nerve cold nodule. If it’s hot, it’s malignant. You will § Parathryoid see if iodine will localize in that nodule. Chvostek sign vs. Trousseau’s FNAB or Fine Needle Aspiration Biopsy § Chvostek sign is the twitching of the • Mass is aspirated with needle facial muscles in response to tapping • Histopath: (+) over the area of the facial nerve. § Trousseau’s sign is carpopedal spasm Fine Needle Aspiration of a thyroid nodule is the caused by inflating the blood pressure investigation of choice in a patient with a solitary cuff to a level above systolic pressure. nodule of the thyroid, as it is very successful in obtaining cells for cytologic examination and thus in the diagnosis of thyroid carcinoma. It can Recurrent Laryngeal Nerve usually be performed under local anaesthesia. § (review of Mediastinum) This patient had a recurrent nodule after § If injured, previous partial thyroidectomy for thyrotoxicosis. o Difficulty in breathing o Hoarseness Multi-nodule Superior Thyroid Artery – External Laryngeal • Nodule is a solid mass. Nerve • If it has only 1 solid mass: “Nodular § If injured, it will affect the pitch. Goiter”
MINI QUIZ: Subtotal Thyroidectomy
§ removes PART of thyroid 1. Structure located on the posterior surface of § Total Thyroidectomy – removes ALL the thyroid gland? Parathyroid Gland. thyroid 2. Electrolyte deficiency seen in the patient?
Hypocalcemia. Thyroid Gland 3. Structure that is if injured will cause difficulty § Butterfly in shape in breathing? Recurrent Laryngeal Nerve § Bilobed;; 4. Where does RLN arise from? Vagus Nerve § Connected by Isthmus in the middle 5. Give 1 blood supply of the thyroid gland?
Superior Thyroid Artery, Inferior Thyroid The Thyroid Gland is the main part of the body Artery, Thyroidea Ima that takes up Iodine. In a thyroid scan, Iodine is
labeled with a radioactive tracer, and a special -----------------------------xxx------------------------------- camera is used to measure how much tracer is
absorbed from the bloodstream by the thyrid
gland. If a patient is allergic to Iodine, technetium can be used as an alternative.
Tingling of hands and feet and Carpopedal Spasm: signs of HYPOCALCEMIA.