Anatomy 2 Flashcards
(245 cards)
1
Q
what are the male reproductive organs
A
testes
2
Q
how long is the male urethra
A
~20cm
3
Q
is the male internal urethral sphincter under voluntary or involuntary control
A
involuntary (in bladder neck)
4
Q
is the male external urethral sphincter under voluntary or involuntary control
A
voluntary (where prostatic urethra becomes spongy urethra)
5
Q
what is the spongy urethra within
A
the corpus spongiosum
6
Q
what is the most anterior organ in the pelvis
A
bladder
7
Q
where is the prostate in relation to the bladder
A
inferior
8
Q
what pouches do males have
A
only rectovesicle
9
Q
what are the points of the trigone of the bladder
A
2 ureteric orifices
internal urethral orifice
10
Q
what lines the bladder
A
detrusor muscle
fibres encircle ureteric orifices and tighten when bladder contracts (prevents reflux of urine)
11
Q
what muscle makes up the internal urethral sphincter
A
detrusor
12
Q
do females have an internal urethral sphincter
A
no
13
Q
what is the role of the internal urethral sphincter
A
contracts during ejaculation to prevent retrograde ejaculation
14
Q
what canal do the testes go though
A
inguinal
15
Q
what is in the spermatic cord
A
testicular artery and vein
vas deferens
lymphatic vessels
nerves (autonomic- vas deferns, somatic -cremaster)
16
Q
what muscles does the inguinal canal go through
A
transversus abdominus, internal ad external oblique
17
Q
what is the conjoint tendon
A
the medial end of the combined aponeurosis of internal oblique and transversus abdominis - anchors muscles inferiorly to pubic bone
18
Q
what is the spermatic cord
A
3 layers of covering gained as testes pass through the inguinal canal- external spermatic fascia, cremasteric fascia, internal spermatic fascia
and the structures contained within
19
Q
what do the testes sit in within the scrotum
A
tunica vaginalis
20
Q
what is a hydrocele
A
excess fluid within the tunica vaginalis
21
Q
what are the two layers of tunica vaginalis
A
visceral and parietal layers (fist in balloon)
22
Q
what is the temperature of the testes
A
~1 degree less than core body temp
23
Q
how long does it take sperm to mature
A
64 days
24
Q
where is sperm produced
A
seminiferous tubules
25
how does the dartos muscle control testes temp
within superficial fascia of the scrotum contracts:
wrinkle/ thicken scrotal skin
reduce the scrotal area of the scrotum (reduces heat loss)
26
what is the path of sperm
```
seminiferous tubules
rete testis
head of epididymis
tail of epididymis
vas deferens
(combines with seminal gland duct) ejaculatory duct
prostatic urethra
spongy urethra
```
27
what is the normal size of teste
~5 cm length
| ~12-25 ml volume
28
what gets twisted in testicular torsion
spermatic cord- cuts off blood supply to testes = severe pain and risk of necrosis
29
where is the epididymis
posterior aspect of the tesis
| proximal end is located at the posterior aspect of the superior pole of the testes
30
can the vas deferens be palpated within spermatic cord
yes- in scrotum superior to testes
31
what is the venous drainage of the testes
left testicular vein to left renal vein
| right TV to IVC
32
what is the blood supply to the testes
gonadal arteries (branch off aorta at L2)
33
what are the roles of the prostatic urethra
drains urine from bladder
| passes semen in ejaculation
34
what does the seminal gland do
produces seminal fluid
35
what is semen rich in
fructose
36
what do bulbourethral (cowpers) glands go
mucus secretion- lubricates urethra and neutralises acidity
37
what shape is the prostate
walnut shaped
38
what is the inferior aspect of the prostate in contact with
levator ani
39
what goes through the prostate ducts
glandular secretions from the prostate drain into prostatic urethra
40
what is the opening of the ejaculatory duct
combined duct of the vas deferens and the duct from the seminal gland
41
where do most prostate cancer arise
in peripheral zone
42
what is the path of the vas deferens
passes superiorly in spermatic cord
deep inguinal ring
turns medially into pelvis
travels posteriorly to bladder
43
what goes into ejaculatory duct
seminal vesicle and vas deferens
44
what is semen
sperm and seminal fluid
45
when do right and left prostatic ducts join
within prostate gland - drain into urethra
46
what happens in a vasectomy
the vas deferens is transected and its lumen is sutures closed (bilaterally)
47
what is the anatomical position of the penis
erect
48
what is paraphimosis
when retraction of the prepuce (foreskin) can constrict the neck of the glans causing the glans to swell
49
what is the root of the penis laterally attached to
ischium of pelvis
50
what is behind an erection
3 cyclinders (corpus cavernosum, corpus spongiosum) of erectile tissue become engorged with blood at arterial pressure
51
what is the corpus carvernosum
right and left
posterior to urethra (when erect)
transmits the deep arteries of the penis
52
what is the corpus spongiosum
anterior
transmits spongy urethra
expands distally to forms the glans penis
53
what is the superficial perineal pouch (in males)
lies below the perineal membrane
contains the root of the penis (bulb -> corpus spongiosum. Crura-> corpus cavernosum) and associated muscles (bulbospongiosus and ischiocavernosus)
also contains:
- proximal spongy urethra
- superficial transverse perineal muscle
- branches of internal pudendal vessels
- pudendal nerve
54
what is the blood supply to the penis
via the deep arteries of the penis: branches from the internal pudendal artery, from internal iliac
55
what is the blood supply to the scrotum
via the internal pudendal and branches from external iliac artery
56
where does lymph from scrotum and most penis (not glans) drain to
superficial inguinal lymph nodes (in superficial fascia of groin)
57
where does lymph from the testes drain to
lumbar nodes- around abdominal aorta
58
what folds are on the internal aspect of the abdo wall
lateral umbilical fol (inferior epigastric vessels)
medial umbilical fold (remnant of the umbilical artery)
median umbilical fold (urachus)
59
what is the action of the obturator internus and piriformis
laternal rotator of the hip
60
what nerve is the piriformis a landmark for
sciatic nerve- passes underneath
61
where do the arteries of the pelvis and perineum arise from
majority internal iliac
exceptions:
-gonadal (L2 abdo aorta)
-superior rectal artery (continuation of inferior mesenteric)
62
what are the divisions of the internal iliac artery
anterior (visceral) and posterior (parietal)
63
what is the median umbilical ligament
remnant of the umbilical artery which connected the internal iliac to the placenta
64
do females have an inferior vesicle
no - replaced by vaginal artery
65
what branches come off the posterior division of the internal iliac
gluteal arteries (superior and inferior)
66
what branches come off the anterior division of the internal iliac artery
```
obturator
superior and inferior vesical arteries
internal pudendal
middle rectal
prostatic branch of inferior vesical artery
```
67
where do most branches of vessels to the male perineum come from
```
internal pudendal
(anterior scrotal is different as it comes from external iliac)
```
68
what artery supplies the spongiosum and glans
dorsal artery of penis
69
what artery supplies the carvernosum and glans
deep artery of penis
70
what does the vaginal artery give of branches to
supply the inferior bladder
71
what is the uterine artery a homolog of
the artery to the vas deferens
72
what artery is most at risk in a hysterectomy
uterine
73
what does the vaginal artery branch from
uterine artery (can vary)
74
describe the path of the ovarian artery
divides into tubal and ovarian branches
| these then rejoin to form ovarian artery which anastomoses with the uterine artery to supply to uterus
75
what does the uterine artery anastomose with
ovarian artery -> supply uterus
| vaginal artery -> supply vagina
76
what structure passes under the uterine artery- why is this important
ureter
| ligating uterine artery in a hysterectomy puts ureter at risk
77
what is the blood supply to the female perineum
```
internal iliac (ant division)
internal pudendal:
-inferior rectal
-labial arteries
-dorsal artery of clitoris
```
78
what is the venous drainage of the pelvic
mainly drains to internal iliac (via veins named same as arteries)
some drains via superior rectal into hepatic portal system
some will drain via lateral sacral veins into internal vertebral venous plexus (importanfor spread of infection/ cancer - osteomyelitis)
79
why does ureter damage happen more commonly on the left
as left is more medial and crosses the common iliac (right crosses the external iliac)
80
what are the nerves of the lateral pelvic wall
```
obturator nerve
nerves from sacral plexus:
-pudendal
-sciatic
-pelvic splanchnic
-nerve to levator ani
```
81
what splanchnic nerves contain parasympathetics
pelvic splanchnic
82
name the lymph nodes of the pelvis
```
deep and superficial inguinal
pararectal
sacral
external and internal iliac
common iliac
inferior mesenteric
lumbar
```
83
where does the superior pelvic viscera lymph drain to (superior rectum, bladder, uterus)
- external iliac nodes
- common iliac
- aortic
- thoracic duct
- venous system
84
where does the inferior pelvic viscera lymph drain to (inferior bladder, rectum, superior vagina and inferior uterus)
```
deep perineum
internal iliac
common iliac
aortic
thoracic duct
venous system
```
85
where does lymph from the superficial perineum drain to
superficial inguinal nodes
86
where does lymph from the ovaries and testes drain to
lumbar
87
where does lymph from the clitoris and glans go to
deep inguinal
88
what is transperitoneal spread
disease can penetrate the peritoneal layer and disseminate into the peritoneal cavity
89
where does most of the arterial blood supply to the lateral pelvic wall come from
```
internal iliac
(gonadal arteries come from the abdominal aorta)
```
90
what makes the venous drainage of the lateral pelvic wall inmportant
forms lots of plexuses
91
what do the nerves on the lateral wall of the pelvis supply
```
lower limb (obturator and sciatic)
perineum (pudendal)
```
92
describe the lymphatic drainage of the lateral pelvic wall
very varibale
gonadal to lumbar
facilitates transperitoneal spread
93
what divides the scrotum in two
a fibromuscular septum
94
what does contraction of the dartos muscle do
gives the scrotum a corrugated appearance and is used to raise the testis closer to the body in cold conditions
95
what is normal testicular volume
12-25 mls
| should be ~5cm in length
96
what might cause reduced testicular volume
any condition that causes testicular failue: Klinefelters syndrome, post- chemotherapy or post-orchitis
97
where is the epididymis in testes exam
lies along the posterolateral border of each testis, head at superior pole
98
can you palpate the epididymis
if normal, is difficult to palpate. However, if there is obstruction the epididymis becomes distended and can be palpated
99
can the vas deferens be palpated
may be palpated in the spermatic cord as a firm tubular structure
100
what conditions cause the vas to be absent
cystic fibrosis
101
what is phimosis
when the male foreskin is not retractable
102
what encapsulates each testis
tunica albuginea
103
what is the tunica vaginalis
double layer of peritoneum that encloses the testis and epididymis within the scrotum
104
what is a hydrocele
collection of fluid between the parietal and visceral layers of the tunica vaginalis
105
what happens to the epididymus as the inferior pole of the testes
becomes the vas deferens
106
what embryological remnant are at the upper pole of the testis and epididymis
Appendix testis (from paramesonephric duct) and Appendix epididymis (from mesonephric duct)
107
where is the vas deferens in relation to the testes
It is continuous with the tail of the epididymis, and lies medial to the epididymis on the posterior aspect of the testis
108
what is the path of the vas deferens
ascends within the scrotum (accompanied by the testicular vessels), through the spermatic cord to enter the inguinal canal through the superficial inguinal ring in external oblique aponeurosis. It then passes through the deep inguinal ring, immediately lateral to the inferior epigastric artery, to enter the abdomen. The vas passes above and medial to the ureter as it descends into the pelvis to meet the seminal vesicle. Just before doing so, it dilates as the ampulla, which joins the duct from the seminal vesicle to form the ejaculatory duct. The ejaculatory duct passes through the prostate to join the prostatic urethra
109
what supplies the vas
the artery to the vas, derived from the superior vesical artery
110
where are the seminal vesicles
behind the bladder
111
what is the blood supply of the prostate
branches from the inferior vesical artery, but drained by a plexus of prostatic veins to the internal iliac vein
112
what is the role of the epididymis and vas
Exit route from testes to urethra, concentrate & store sperm, site for sperm maturation
113
what is the role of seminal vesicles
Produce semen into ejaculatory duct, supply fructose, secrete prostaglandins (stimulates motility), secrete fibrinogen (clot precursor)
114
what is the role of the prostate gland
Produces alkaline fluid (neutralizes vaginal
| acidity), produces clotting enzymes to clot semen within female
115
what is the role of bulbourethral glands
Secrete mucus to act as lubricant
116
which part of penis contains the urethra
corpus spongiosum (ventral)
117
what muscle surrounds the corpus spongiosum
bulbospongiosus
118
what forms the glans penis
corpus spongiosum
119
how is the urethra not obstructed in erection
as fascia surrounding corpus spongionsum is thin
120
what forms the corpus cavernosum
formed from two crura (each attacjed to the ischiopubic ramus) surrounded by ischiocavernous muscle
121
how does parasympathetic create an erection
blocks sympathetic vasoconstriction and allows increased blood flow for erection
122
where do you the testicular and ovarian arteries leave aorta
L2
123
what lymph nodes to the testes drain to
para aortic
124
what nerves level supplies the testes
T10 and T11
125
where does testicular and ovarian pain refer to
peri umbilical region (T10-11)
126
what is the venous drainage of the testes
The right testicular (and ovarian) veins drain to the IVC, the left to the left renal vein
127
what is a varicoele
when the veins around the testis become distended and elongated
128
why is a varicoele more common on the left
as the vein joins the higher pressure left renal vein (whereas the right joins the inferior vena cava)
129
when does the uterine fundus arise outwith the pelvis
at 12 weeks gestation
130
what is the pubic crest
the ridge on the superior surface of the pubic bone medial to the pubic tubercle
131
what level is the iliac crest
L4
132
where is the inguinal ligament palpated
between the anterior superior iliac spine and the pubic tubercle
133
name this artery:
(a branch of the external iliac artery) ascends from just superior to the inguinal ligament (medial to the deep inguinal ring) to run in a medial direction behind the rectus muscle
inferior epigastric
134
what does the rectis abdominis attach to
the front of the symphysis pubis and the pubic crest, and is inserted into costal cartilages 5, 6 and 7
135
The external oblique, internal oblique and transversus abdominis muscles arise from and insert to ?
iliac crest, ribs and linea alba
136
what is the direction of fibres of abdominal muscles
external oblique pass downward and medially (hands in pockets), internal oblique upward and medially, transversus abdominis transversely
137
what forms the linea alba
aponeurosis of external and internal oblique, transversus and aponeurosis abdominus combone to form the rectus sheath which then forms the linea alba
138
what forms the inguinal ligament
the inferior edge of the external oblique aponeurosis
139
what does the inguinal ligament run between
ASIS and pubic tubercle
140
what is the pyramidalis
a small triangular muscle which arises from the anterior surface of the pubis and is inserted into the linea alba
141
what is the path of the fundus during pregnancy
The uterine fundus can usually start to be palpated above the pubic symphysis from 12 weeks gestation, by 20 weeks it reaches around the umbilicus and from here it grows at about 1 cm per week until reaching near the xiphisternum at around 36 weeks
142
when does the symphysiofundal height n cm equal the gestation
from 20 weeks onwards +/- 3 cmq
143
what does a midline verticle incision go through
the linea alba- relatively avascular
144
what structures are incised in a C section
```
skin
superficial fascia
rectus sheath (only anterior layer)
rectus muscles separated not incised
parietal and visceral peritoneum incised
uterus and amniotic sac
```
145
why do you need to suture the rectus sheath after c section
to prevent hernia formation
146
what is the rectus sheath
strong fibrous structure, which encloses rectus abdominis and is created from the aponeuroses of external oblique, internal oblique and transversus abdominis
147
what artery is at risk in laparoscopy
inferior epigastric artery
148
what is the sruface marking of the inferior epigastric artery
immediately medial to the deep inguinal ring at the midpoint of the inguinal ligament (ASIS to pubic tubercle), or it is superior to the femoral pulse felt at the mid-inguinal point (ASIS to pubic symphysis). The artery passes obliquely up the abdomen towards a point about 2 to 3 cms lateral to the umbilicus.
149
what is the inferior epigastric artery a branch of
the external iliac artery
150
what is the path of the external iliac artery
runs up from above the inguinal ligament, piercing the transversalis fascia to ascend behind the rectus sheath and anastomoses with the superior epigastric artery. Together they supply the central part of the abdominal wall.
151
what is the neurovascular supply to the abdo wall
The intercostal neurovascular bundles between ribs 7 to 12, the subcostal bundle inferior to rib 12, and branches of the L1 spinal nerve
152
what is the position of the ovary
lies against pelvic wall in ovarian fossa
| ureter and internal iliac vessels run behind it, obturator nerve runs lateral
153
what suspends the uterus
uterine arteries
154
what are the uterine arteries branches of
internal iliac
155
what supplies the fundus
ovarian arteries
156
what is the venous drainage of the uteris
internal iliac and ovarian veins
157
where does the ovarian artery leave the aorta
L2
158
what suspends the ovaries
broad ligament (double fold of peritoneum)
159
what fornix is the pouch of douglas close to
posterior fornix of vagina
160
what is the mesosalpinx
part of broad ligament that stretches from ovary to fallopian tube
161
are the ovaries intra or retroperitoneal
intra- peritoneum combines with ovary wall
162
how does ovarian cancer spread
via lympahtics (pelvic and para aortic nodes) and direct peritoneal spread (implants on omentum and peritoneal surfaces of bowel and liver)
GI tract, bladder, liver spleen
distant sites- lungs
163
when does bladder rise out of pelvis
when full or in labour
| lift peritoneum off anterior abdo wall
164
what is the course of pelvic lymph drainage
deep and superficial iliac drain to external iliac
sacral, external and internal iliac drain to common iliac which drain to lumbar and inferior mesenteric
these drain to lumbar trunk which coalesce to form the cisterna chyli (continues as the thoracic duct)
165
where are the inguinal lymph nodes
outside the fascia lata and shaped like a “T” below and parallel to the inguinal ligament, and along the termination of the long saphenous vein; and a deep group (deep to the fascia lata) just medial to the femoral vein and in the femoral canal.
166
what drains to the inguinal nodes
superficial elements of the perineum
167
whats nodes does the rectum drain to
sacral and internal iliac
168
whats nodes does the anal canal drain to
internal iliac, but lower canal to superficial inguinal
169
whats nodes does the bladder drain to
internal and external iliac
170
whats nodes does the Prostate and proximal urethra (male and female) drain to
internal iliac
171
whats nodes does the Distal, penile urethra, penis and clitoris drain to
superficial inguinal
172
what nodes does the testes and ovaries drain to
para aortic
173
what nodes does the Uterine tube, uterine fundus and upper uterine body drain to
para aortic
174
what nodes does the Lower uterus, cervix and proximal vagina drain to
internal and external iliac
| sacral
175
what nodes does the distal vagina and vulva drain to
superficial inguinal
176
when is the ureter at risk
when ligating uterine artery
in ovarian fossa -adhesions/ endometriosis
colon surgery- passes on post abdo wall under sup and inf mesenteric vessels
177
what is the nerve supply of the detrusor muscle
parasympathetic nerves derived from the pelvic splanchnics S2,3,4
178
what supplies the urethral smooth muscle
sympathetic nerves T10-L2
| towards bladder and urethra is hypogastric nerves
179
what supplies the striated urethral sphincter muscle
branches of the pudendal S2,3,4
180
what nerve influence allows for storage of urine
sympathetic
tone in urethral sphincter and levator ani
(overrides para to detrusor muscle)
181
what nervous influences allow urine voiding
parasympathetics P for P
via pelvic splanchnic nerves S2,3,4
detrusor contraction and relaxation of overrides symp, relaxing urethral sphincter and levator ani
(pudendal nerve also senses urine in urethral which maintains micturition reflex)
182
what is the role of the male internal urethral sphincter
prevents back flow of semen into bladder at ejaculation
183
what is the vulva
collective name given to the female urogenital triangle structures the mons pubis, the labia majora, the labia minora, vestibule, vaginal orifice, orifices of the vestibular glands and the clitoris
184
what part of levator ani does the vagina pass through
pubovaginalis
185
what muscle type lines the vagina
smooth
186
why is the lateral fornix important
larger
distensible- can hide foreign bodies
directly related to pouch of douglas
187
in females what does the external urethral sphincter encircle
urethra and vagina
188
what supplies sensation to the vaginal and urethra
pudendal
189
what is the blood supply to the vagina and urethra
uterine, vaginal and internal pudendal branches of the internal iliac artery. Venous drainage is via the vaginal plexus, draining to the internal iliac veins
190
what is the lymph drainage of the vagina and urethra
upper vagina and urethra is to the iliac nodes and the lower to the superficial inguinal nodes
191
what muscle overlies the bulb of erectile tissue in female
bulbospongiosus
192
what muscle overlies the crura in females
ischiocavernosus
193
what is the membranous urethra in males
part going through urogenital diaphragm
194
what does the spongy urethra go though
bulb of penis and carpus spongiosum
195
what do the bulbourethral ducts do
feed lubricating mucous from the bulbourethral gland into the urethra at the bulb of the penis
196
what contracts in males to expel the last bit of wee
bulbospongiosus muscle (surrounds the bulb)
197
what blood supply to the male urethra
same arteries that supply the prostate and penis supply the urethra (inferior vesical, artery to the bulb, dorsal artery of the penis). Its venous drainage is to the prostatic plexus and internal iliac vei
198
what lymph drainage is the male urethra
internal iliac
199
what is the lymph and vascular Supply to: the Female Vulva and Labia; the Male Penis and
Scrotum
Blood supply is via the external pudendal arteries and veins anteriorly (from the femoral), and the posterior scrotal or labial branches of the internal pudendal arteries and veins posteriorly
lymph sup inguinal
200
lymph drainage of labia
iliac
201
what is the nerve supply of the penis
Nerve supply to the skin of the proximal penis is via L1, the ilio-inguinal nerve. But the rest is supplied by the dorsal nerve of the penis, which is the continuation of the pudendal nerve S2,3,4
202
what is the nerve supply of the clitoris
dorsal nerve of the clitoris and perineal branches of the pudendal nerve
203
what is a greater vestibular gland
bartholins glands
204
what are the borders of the urogenital triangle
pubic symphysis
ischiopubic ramus
ischial tuberosity
tranverse perineal muscle
205
what are the borders of the ischioanal triangle
transverse perineal
ischial tuberosity
sacrotunerous ligamemt
coccyx
206
what are the normal lengths of male and female urethras
f- 4-5cm
| m- 18-22cm
207
what supports the cervix and upper vagina
Uterosacral, transverse cervical and pubocervical ligaments
208
what supports the middle vagina
pelvic fascia
209
what supports the lower vagina
levator ani and perineal body
210
what do the broad and round ligaments maintain
anteversion and anteflexion
211
what ligaments attach to the uterus
round, ovarian, uterosacral, transverse cervical, pubocervical, broad
212
what do the sarcotuberous and sacrospinous ligaments maintain
prevents body weight tilting lower sacrum up and backwards
213
what can loss of pelvic fascia in the lower third of the vagina cause
cytocele and rectocele
214
what does the levator ani arise from
arises between the ischial spine and body of the pubic bone from a white line on the thick fascia overlying obturator internus
passes inferomedially to form a midline raphe with its neighbour from the other side. The raphe passes from coccyx to pubic symphysis
thickens to form the anococcygeal ligament between the coccyx and anorectal junction, and as the perineal body just in front of the anorectal junction and behind the vagina
215
what inserts into the anococcygeal ligament (thickening of levator ani)
Iliococcygeus and pubococcygeus
216
what is the role of the obturator internus
Its tendon passes inferior to the ischial spine (with the 2 gemelli) to insert on the medial aspect of the greater trochanter and laterally rotate the hip (nerve to obturator internus, L5, S1).
217
what can damage pelvic floor support
Increased intra-abdominal pressure – obesity, chronic cough, occupational/recreational exercise, constipation, intra-abdominal mass
Pelvic floor muscle trauma and denervation - obstetric trauma, pelvic fracture or surgery, congenital
Connective tissue disorder - Age related, Oestrogen deficiency, Congenital or acquired connective tissue disorders, Drug related: e.g. steroids
218
what are the proximal and distal attachments of coccygeus
p- ischial spin
| d- Inferior end of sacrum and coccyx
219
what are the proximal and distal attachments of puborectalis
p-body of pubis
| d-perineal body
220
what are the proximal and distal attachments of pubococcygeus
p-Pubic bone, Tendinous arch of obturator fascia
| d- Vagina, perineal body, rectum, coccyx
221
what are the proximal and distal attachments of iliococcygeus
p-Ischial spine and tendinous arch
| d- Perineal body, coccyx
222
what is the role of pubococcygeus
forms a large part of the pelvic floor; compresses the urethra, vagina, and anus. It also controls urine flow and elevates the recto-anal junction
223
what is the role of iliococcygeus
compresses the urethra, vagina, and anus; elevates the recto-anal junction
224
what is the nerve supply to the levator ani
Nerve to levator ani (S4), along with branches from the pudendal nerve, S2, 3, 4.
225
what passes behind the sacrospinous ligament
pudendal nerve, artery and vein (lie within the pudendal canal)
226
what forms the ischioanal fossa
Obturator internus muscle, and its fascia, overlies the ischial tuberosity to form the lateral wall
roof is formed by levator ani and the anal canal, surrounded by the external anal sphincter, is medial.
227
what passes through the ischioanal fossa
pudendal neurovascular bundle
| inferior rectal neurovascular bundle
228
what is the clinical relevance of the ischioanal fossa
allows rectal expansion during defecation
spread of abscesses (can spread to other side via post anal space- creates horseshoe shape)
blockage of the pudendal nerve in order to operate on the perineum and the lower vagina or anus.
229
what must be identified to perform a pudendal nerve block
ischial spine (anesthetic solution is pumped around the spine in order to reach the nerve, which hooks around the structure)
230
what is at risk when inserting a trochar through obturator membrane
obturator neurovascular bundle (goes through obturator canal)
231
where does the breast and nipple sit on the chest
breast:
- between ribs 2-6
nipple:
- T4
- 4th intercostal space
232
what muscles does the breast sit on
most pec major
| some serratus anterior and superior aspect of the external oblique
233
what is between the breast on pec major - what is the clinical importance
retromammary space
| allows breast to move relative to muscle
234
what are the groups of lymph nodes within the axilla
```
APICAL:
A- anterior
P-posterior
I-infraclavicular
C-central
A-apical
L-lateral
```
235
what does a fixed lump in the breast suggest
invasion into retromammary space and muscle
236
what is the lymph drainage of the breast
intramammary nodes:
- axillary pathway: to axillary nodes
- internal mammary nodes: can cross to other side
- retromammary pathway: to subclavicular plexus
left breast ultimately goes to thoracic duct and then left subclavian vein
right -> right subclavian vein
237
what are the division of the axillary lymph nodes
level 1- inferior/lateral
to pec major
level 2- posterior to pec major
level 3- superior/ medial to pec major
238
what level of nodes are the breast sentinel nodes
1
239
what changes happen to the breast in pregnancy and post menopause
pregnancy- lobules enlarge, proliferate and start lactating
PM- loose fibrofatty tissue, become less dense, loose elasticity of collagen
240
why can prolactinoma cause amenorrhea
reduces oestrogen
241
drug for prolactinoma
cabergoline (dopamine agonist)
242
what angle should a vaginal speculum be inserted in order to view the cervix
45 degree downwards, towards back
243
what is the pouch of douglas
rectouterine pouch
| lower part in standing female
244
what arteries and veins supply the uterus
uterine (from internal iliac) and ovarian (supply the fundus) arteries anastomose together
ovarian and internal iliac veins
245
what are the features of a threatened miscarriage and what would you see on USS
bleeding but not passed fetal material
(highly likely to not be viable)
when CRL <6cm, gestation <20 weeks
on USS will see fetus, amniotic and yolk sac
