GU ANATOMY AND PHYSIOLOGY

1. GU ANATOMY AND PHYSIOLOGY and HISTORY & PHYSICAL EXAM

2. 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

4. GROSS ANATOMY

5. 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

6. HISTOLOGY • Functioning units of the kidneys are nephrons • Secretory portion contained in the cortex • Excretory portion is the collecting tubule

7. 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

9. URETERS • Two ureters • Narrow tubes carry urine from the kidneys to the bladder • Adult ureter 30 cm long

10. STONES

11. 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

14. 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

15. 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

16. 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

18. 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

19. Digital Rectal Exam

20. 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

21. 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

22. Normal Male Anatomy

23. Paraphimosis

24. 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.

26. FEMALE PELVIC ANATOMY • Ovaries • Uterine fallopian tubes • Uterus • Cervix • Urinary bladder • Ureters • Vagina • Rectum

27. 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

31. NORMAL DEVELOPMENT OF THE GU SYSTEM • Three embryonic kidneys pronephros 3 weeks mesonephros 5 weeks metanephros 5 weeks Nephrogenesis complete at 34 – 36 weeks

33. 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

34. GU ASSESSMENT OF THE INFANT AND CHILD • Abdomen: pain, masses • External genitalia: normal or abnormal • Consider sexual abuse: must be reported

35. Tanner System

38. Balanitis

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

40. 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

41. DIGITAL RECTAL EXAM • Prostate gland: size, symmetry, nodularity, tenderness • Sphincter tone, presence of hemorrhoids, rectal masses

42. 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

43. Female • Cervix: general appearance, lesions, discharge • Uterus: size, contour, position, mobility, tenderness, consistency, descent or support • Adnexa: masses, tenderness, organomegaly • Anus, perineum