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Samenvatting ovv: anatomie
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Samenvatting ontwikkeling, voortplanting en verloskunde (deel anatomie, gegeven door Wouter Willaert en Katharine D'Herde)
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Anatomie1: canalis inguinalis
- Voorwand: m. obliquus ext
- Achterwand: fascia transversalis
- Bodem: lig. inguinale van Poupart
- Dak: m. obl int + m. transversus
- fascia spermatica
o interna: van fascia fascia transversalis
o externa: van fascia obl abd ext
o tuss: m. cremaster (afk van m obl abd int) + fascia cremasterica (afk van fascia obl
abd int)
testes omhoog trekken (cremasterreflex)
- funiculus spermaticus: fascia spermatica int + ext + m. cremaster
- annulus inguinalis
o superficialis: 1 cm cran + lat van tuberculum pubicum
crus lat + med + fibrae intercrurales
o profundus: cran van lig inguinale, begin fasc sperm int
- anulus femoralis
- lig inguinale: spina iliaca ant sup – tub pubis
o lig lacunare van Gimbernat: driehoekig
o lig pectineale van Cooper
o lig reflexum Collesi: crus lat, richting linea alba
- lig interfoveolare van Hesselbach: van fascia transversalis
- plica umbilicalis
o lateralis: a/v epigastrica inf
tuss lat en med: fossa inguinalis medialis
lat van lat: fossa inguinalis lat (annulus ing prof)
o medialis: overblijfsel a. umbilicalis
tuss med en med: fossa supravesicalis
o mediana: overblijfsel urachus
- fascia abdominis superficialis
o vetlaag: Camper
o membraneuze laag: Scarpa – Colles – lata
- falx inguinalis: m. transv abd + m. obl abd int
- corona mortis : anastomose a. obturatoria (a. obturatoria accessoria) en a. iliaca ext
Man
- lig. suspensorium penis: symfysis pubis – fascia penis prof
- lig. fundiforme penis: linea alba (fascia van Scarpa) – fascia penis superf
- m. cremaster
o inn: aff: ramus femoralis + eff: ramus genitalis (n. genitofemoralis)
o bv: a. cremasterica (a. epigastrica inf)
- funiculus spermaticus
o ductus deferens
GSP => ejaculatie
Bocht rond a. epigastrica inf
1
, Bv: a. ductus deferentis (a. iliaca int)
Inn: OS
o a/v testicularis
vena => plexus pampiniformis !varicocele (gestoord temp regulatie)
R vena -> VCI
L vena -> v. renalis
a uit ao
o ramus genitalis
m. cremaster + sens inn huid scrotum
o lymfebanen
o takken T10-12
inn testis + epididymis
Vrouw
- lig. Teres uteri
- a. ligamenti teretis
- lymfebanen => lnn. Inguinales sueperficiales
- ramus genitalis: sens inn grote schaamlippen
Herniae inguinales
Direct
- verworven
- vanuit fossa inguinalis medialis (lig van Hesselbach)
- breukpoort: annulus inguinalis superficialis (med van a. epigastrica inf)
- peritoneum + fascia transversalis + falx + fascia spermatica ext (geen fascia cremasterica)
- boven tuberculum pubicum
Indirect
- verworven/congenitaal
- doorheen lieskanaal: alle omhulsels
- breukpoort: annulus inguinalis profundus (lat van a. epigastrica inf)
o minder wijde opening !strangulatie bloedvoorziening organen
- behandeling: resectie breukzak + versterking achterwand lieskanaal
- congenitaal: embryonale rest: processus vaginalis => vocht in scrotum: hydrocele
Hernia femoralis
- breukpoort: anulus femoris (med van a/v femoralis)
- vooral bij vrouwen
- breukzak: peritoneum + fascia transv
- lat van lig lacunare
2: scrotum en testes
Omhulsels testes
m. dartos + huid
- contractie bij koude: verrimpelde huid + optrekken testes
fascia superficialis
- membraneuze laag: fascia van Colles
2
, fascia spermatica externa
fascia cremasterica
fascia spermatica interna
tunica vaginalis
- ventr, lat, med, inf (niet dors)
- lamina visceralis + parietalis
- mesorchium: overgang par – visc blad
- !hydrocele
tunica albuginea
- Bw laag rond testis
Uitwendige structuur testes
- Bovenkant: anterolat, onderkant: posteromedial
- L testis lager
Inwendige structuur testes
- Tunica albuginea: septula verdelen testis in lobuli
- Lobuli => tubuli seminiferi => mediastinum testis: rete testis => ductuli efferentes
- Tuss tubuli seminiferi: capillairen + cellen van Leydig (prod testosteron)
- In tubuli seminiferi: Sertolicellen (prod MIS)
- Appendix testis: overblijfsel kanaal van Müller
Vascularisatie
Arteriën
- Art funiculus spermaticus + a. pudenda ext (a. femoralis)
Venen
- Vv. testiculares => plexus pampiniformis
- v. pud ext + v. scrotalis post + v. cremasterica + v. deferentialis
Lymfedrainage
- => Lnn. Para-aortici
Innervatie
- Motorisch?
- OS: ejaculatie
o T10-12, parallel met testiculaire vaten
- PS: emissie, sperma naar ampulla
o S2-4: nn. splanchnici pelvici
Torsio testis
- Testes gedraaid in funiculus spermaticus
- Sterke contracties cremastes + lang mesorchium
- !compressie testiculaire vaten => necrose testes
- Orchiopexy: beide testes in positie vasthechten
Epididymis
- Cran + dors van testis
3
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