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Reproduction > Anatomy 2 > Flashcards

Anatomy 2 Flashcards

1
Q

what are the male reproductive organs

A

testes

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2
Q

how long is the male urethra

A

~20cm

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3
Q

is the male internal urethral sphincter under voluntary or involuntary control

A

involuntary (in bladder neck)

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4
Q

is the male external urethral sphincter under voluntary or involuntary control

A

voluntary (where prostatic urethra becomes spongy urethra)

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5
Q

what is the spongy urethra within

A

the corpus spongiosum

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6
Q

what is the most anterior organ in the pelvis

A

bladder

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7
Q

where is the prostate in relation to the bladder

A

inferior

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8
Q

what pouches do males have

A

only rectovesicle

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9
Q

what are the points of the trigone of the bladder

A

2 ureteric orifices

internal urethral orifice

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10
Q

what lines the bladder

A

detrusor muscle

fibres encircle ureteric orifices and tighten when bladder contracts (prevents reflux of urine)

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11
Q

what muscle makes up the internal urethral sphincter

A

detrusor

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12
Q

do females have an internal urethral sphincter

A

no

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13
Q

what is the role of the internal urethral sphincter

A

contracts during ejaculation to prevent retrograde ejaculation

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14
Q

what canal do the testes go though

A

inguinal

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15
Q

what is in the spermatic cord

A

testicular artery and vein
vas deferens
lymphatic vessels
nerves (autonomic- vas deferns, somatic -cremaster)

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16
Q

what muscles does the inguinal canal go through

A

transversus abdominus, internal ad external oblique

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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

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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

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19
Q

what do the testes sit in within the scrotum

A

tunica vaginalis

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20
Q

what is a hydrocele

A

excess fluid within the tunica vaginalis

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21
Q

what are the two layers of tunica vaginalis

A

visceral and parietal layers (fist in balloon)

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22
Q

what is the temperature of the testes

A

~1 degree less than core body temp

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23
Q

how long does it take sperm to mature

A

64 days

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24
Q

where is sperm produced

A

seminiferous tubules

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25
Q

how does the dartos muscle control testes temp

A

within superficial fascia of the scrotum contracts:
wrinkle/ thicken scrotal skin
reduce the scrotal area of the scrotum (reduces heat loss)

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26
Q

what is the path of sperm

A 
seminiferous tubules
rete testis
head of epididymis 
tail of epididymis 
vas deferens 
(combines with seminal gland duct) ejaculatory duct 
prostatic urethra 
spongy urethra
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27
Q

what is the normal size of teste

A

~5 cm length

~12-25 ml volume

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28
Q

what gets twisted in testicular torsion

A

spermatic cord- cuts off blood supply to testes = severe pain and risk of necrosis

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29
Q

where is the epididymis

A

posterior aspect of the tesis

proximal end is located at the posterior aspect of the superior pole of the testes

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30
Q

can the vas deferens be palpated within spermatic cord

A

yes- in scrotum superior to testes

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31
Q

what is the venous drainage of the testes

A

left testicular vein to left renal vein

right TV to IVC

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32
Q

what is the blood supply to the testes

A

gonadal arteries (branch off aorta at L2)

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33
Q

what are the roles of the prostatic urethra

A

drains urine from bladder

passes semen in ejaculation

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34
Q

what does the seminal gland do

A

produces seminal fluid

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35
Q

what is semen rich in

A

fructose

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36
Q

what do bulbourethral (cowpers) glands go

A

mucus secretion- lubricates urethra and neutralises acidity

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37
Q

what shape is the prostate

A

walnut shaped

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38
Q

what is the inferior aspect of the prostate in contact with

A

levator ani

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39
Q

what goes through the prostate ducts

A

glandular secretions from the prostate drain into prostatic urethra

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40
Q

what is the opening of the ejaculatory duct

A

combined duct of the vas deferens and the duct from the seminal gland

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41
Q

where do most prostate cancer arise

A

in peripheral zone

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42
Q

what is the path of the vas deferens

A

passes superiorly in spermatic cord
deep inguinal ring
turns medially into pelvis
travels posteriorly to bladder

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43
Q

what goes into ejaculatory duct

A

seminal vesicle and vas deferens

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44
Q

what is semen

A

sperm and seminal fluid

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45
Q

when do right and left prostatic ducts join

A

within prostate gland - drain into urethra

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46
Q

what happens in a vasectomy

A

the vas deferens is transected and its lumen is sutures closed (bilaterally)

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47
Q

what is the anatomical position of the penis

A

erect

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48
Q

what is paraphimosis

A

when retraction of the prepuce (foreskin) can constrict the neck of the glans causing the glans to swell

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49
Q

what is the root of the penis laterally attached to

A

ischium of pelvis

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50
Q

what is behind an erection

A

3 cyclinders (corpus cavernosum, corpus spongiosum) of erectile tissue become engorged with blood at arterial pressure

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51
Q

what is the corpus carvernosum

A

right and left
posterior to urethra (when erect)
transmits the deep arteries of the penis

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52
Q

what is the corpus spongiosum

A

anterior
transmits spongy urethra
expands distally to forms the glans penis

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53
Q

what is the superficial perineal pouch (in males)

A

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
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54
Q

what is the blood supply to the penis

A

via the deep arteries of the penis: branches from the internal pudendal artery, from internal iliac

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55
Q

what is the blood supply to the scrotum

A

via the internal pudendal and branches from external iliac artery

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56
Q

where does lymph from scrotum and most penis (not glans) drain to

A

superficial inguinal lymph nodes (in superficial fascia of groin)

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57
Q

where does lymph from the testes drain to

A

lumbar nodes- around abdominal aorta

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58
Q

what folds are on the internal aspect of the abdo wall

A

lateral umbilical fol (inferior epigastric vessels)
medial umbilical fold (remnant of the umbilical artery)
median umbilical fold (urachus)

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59
Q

what is the action of the obturator internus and piriformis

A

laternal rotator of the hip

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60
Q

what nerve is the piriformis a landmark for

A

sciatic nerve- passes underneath

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61
Q

where do the arteries of the pelvis and perineum arise from

A

majority internal iliac
exceptions:
-gonadal (L2 abdo aorta)
-superior rectal artery (continuation of inferior mesenteric)

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62
Q

what are the divisions of the internal iliac artery

A

anterior (visceral) and posterior (parietal)

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63
Q

what is the median umbilical ligament

A

remnant of the umbilical artery which connected the internal iliac to the placenta

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64
Q

do females have an inferior vesicle

A

no - replaced by vaginal artery

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65
Q

what branches come off the posterior division of the internal iliac

A

gluteal arteries (superior and inferior)

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66
Q

what branches come off the anterior division of the internal iliac artery

A 
obturator 
superior and inferior vesical arteries 
internal pudendal 
middle rectal 
prostatic branch of inferior vesical artery
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67
Q

where do most branches of vessels to the male perineum come from

A 
internal pudendal 
(anterior scrotal is different as it comes from external iliac)
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68
Q

what artery supplies the spongiosum and glans

A

dorsal artery of penis

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69
Q

what artery supplies the carvernosum and glans

A

deep artery of penis

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70
Q

what does the vaginal artery give of branches to

A

supply the inferior bladder

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71
Q

what is the uterine artery a homolog of

A

the artery to the vas deferens

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72
Q

what artery is most at risk in a hysterectomy

A

uterine

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73
Q

what does the vaginal artery branch from

A

uterine artery (can vary)

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74
Q

describe the path of the ovarian artery

A

divides into tubal and ovarian branches

these then rejoin to form ovarian artery which anastomoses with the uterine artery to supply to uterus

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75
Q

what does the uterine artery anastomose with

A

ovarian artery -> supply uterus

vaginal artery -> supply vagina

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76
Q

what structure passes under the uterine artery- why is this important

A

ureter

ligating uterine artery in a hysterectomy puts ureter at risk

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77
Q

what is the blood supply to the female perineum

A 
internal iliac (ant division) 
internal pudendal: 
-inferior rectal 
-labial arteries 
-dorsal artery of clitoris
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78
Q

what is the venous drainage of the pelvic

A

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)

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79
Q

why does ureter damage happen more commonly on the left

A

as left is more medial and crosses the common iliac (right crosses the external iliac)

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80
Q

what are the nerves of the lateral pelvic wall

A 
obturator nerve 
nerves from sacral plexus:
-pudendal 
-sciatic 
-pelvic splanchnic 
-nerve to levator ani
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81
Q

what splanchnic nerves contain parasympathetics

A

pelvic splanchnic

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82
Q

name the lymph nodes of the pelvis

A 
deep and superficial inguinal 
pararectal 
sacral 
external and internal iliac 
common iliac 
inferior mesenteric 
lumbar
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83
Q

where does the superior pelvic viscera lymph drain to (superior rectum, bladder, uterus)

A
  • external iliac nodes
  • common iliac
  • aortic
  • thoracic duct
  • venous system
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84
Q

where does the inferior pelvic viscera lymph drain to (inferior bladder, rectum, superior vagina and inferior uterus)

A 
deep perineum 
internal iliac 
common iliac 
aortic 
thoracic duct 
venous system
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85
Q

where does lymph from the superficial perineum drain to

A

superficial inguinal nodes

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86
Q

where does lymph from the ovaries and testes drain to

A

lumbar

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87
Q

where does lymph from the clitoris and glans go to

A

deep inguinal

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88
Q

what is transperitoneal spread

A

disease can penetrate the peritoneal layer and disseminate into the peritoneal cavity

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89
Q

where does most of the arterial blood supply to the lateral pelvic wall come from

A 
internal iliac 
(gonadal arteries come from the abdominal aorta)
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90
Q

what makes the venous drainage of the lateral pelvic wall inmportant

A

forms lots of plexuses

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91
Q

what do the nerves on the lateral wall of the pelvis supply

A 
lower limb (obturator and sciatic) 
perineum (pudendal)
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92
Q

describe the lymphatic drainage of the lateral pelvic wall

A

very varibale
gonadal to lumbar
facilitates transperitoneal spread

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93
Q

what divides the scrotum in two

A

a fibromuscular septum

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94
Q

what does contraction of the dartos muscle do

A

gives the scrotum a corrugated appearance and is used to raise the testis closer to the body in cold conditions

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95
Q

what is normal testicular volume

A

12-25 mls

should be ~5cm in length

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96
Q

what might cause reduced testicular volume

A

any condition that causes testicular failue: Klinefelters syndrome, post- chemotherapy or post-orchitis

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97
Q

where is the epididymis in testes exam

A

lies along the posterolateral border of each testis, head at superior pole

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98
Q

can you palpate the epididymis

A

if normal, is difficult to palpate. However, if there is obstruction the epididymis becomes distended and can be palpated

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99
Q

can the vas deferens be palpated

A

may be palpated in the spermatic cord as a firm tubular structure

100
Q

what conditions cause the vas to be absent

A

cystic fibrosis

101
Q

what is phimosis

A

when the male foreskin is not retractable

102
Q

what encapsulates each testis

A

tunica albuginea

103
Q

what is the tunica vaginalis

A

double layer of peritoneum that encloses the testis and epididymis within the scrotum

104
Q

what is a hydrocele

A

collection of fluid between the parietal and visceral layers of the tunica vaginalis

105
Q

what happens to the epididymus as the inferior pole of the testes

A

becomes the vas deferens

106
Q

what embryological remnant are at the upper pole of the testis and epididymis

A

Appendix testis (from paramesonephric duct) and Appendix epididymis (from mesonephric duct)

107
Q

where is the vas deferens in relation to the testes

A

It is continuous with the tail of the epididymis, and lies medial to the epididymis on the posterior aspect of the testis

108
Q

what is the path of the vas deferens

A

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
Q

what supplies the vas

A

the artery to the vas, derived from the superior vesical artery

110
Q

where are the seminal vesicles

A

behind the bladder

111
Q

what is the blood supply of the prostate

A

branches from the inferior vesical artery, but drained by a plexus of prostatic veins to the internal iliac vein

112
Q

what is the role of the epididymis and vas

A

Exit route from testes to urethra, concentrate & store sperm, site for sperm maturation

113
Q

what is the role of seminal vesicles

A

Produce semen into ejaculatory duct, supply fructose, secrete prostaglandins (stimulates motility), secrete fibrinogen (clot precursor)

114
Q

what is the role of the prostate gland

A

Produces alkaline fluid (neutralizes vaginal

acidity), produces clotting enzymes to clot semen within female

115
Q

what is the role of bulbourethral glands

A

Secrete mucus to act as lubricant

116
Q

which part of penis contains the urethra

A

corpus spongiosum (ventral)

117
Q

what muscle surrounds the corpus spongiosum

A

bulbospongiosus

118
Q

what forms the glans penis

A

corpus spongiosum

119
Q

how is the urethra not obstructed in erection

A

as fascia surrounding corpus spongionsum is thin

120
Q

what forms the corpus cavernosum

A

formed from two crura (each attacjed to the ischiopubic ramus) surrounded by ischiocavernous muscle

121
Q

how does parasympathetic create an erection

A

blocks sympathetic vasoconstriction and allows increased blood flow for erection

122
Q

where do you the testicular and ovarian arteries leave aorta

A

L2

123
Q

what lymph nodes to the testes drain to

A

para aortic

124
Q

what nerves level supplies the testes

A

T10 and T11

125
Q

where does testicular and ovarian pain refer to

A

peri umbilical region (T10-11)

126
Q

what is the venous drainage of the testes

A

The right testicular (and ovarian) veins drain to the IVC, the left to the left renal vein

127
Q

what is a varicoele

A

when the veins around the testis become distended and elongated

128
Q

why is a varicoele more common on the left

A

as the vein joins the higher pressure left renal vein (whereas the right joins the inferior vena cava)

129
Q

when does the uterine fundus arise outwith the pelvis

A

at 12 weeks gestation

130
Q

what is the pubic crest

A

the ridge on the superior surface of the pubic bone medial to the pubic tubercle

131
Q

what level is the iliac crest

A

L4

132
Q

where is the inguinal ligament palpated

A

between the anterior superior iliac spine and the pubic tubercle

133
Q

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

A

inferior epigastric

134
Q

what does the rectis abdominis attach to

A

the front of the symphysis pubis and the pubic crest, and is inserted into costal cartilages 5, 6 and 7

135
Q

The external oblique, internal oblique and transversus abdominis muscles arise from and insert to ?

A

iliac crest, ribs and linea alba

136
Q

what is the direction of fibres of abdominal muscles

A

external oblique pass downward and medially (hands in pockets), internal oblique upward and medially, transversus abdominis transversely

137
Q

what forms the linea alba

A

aponeurosis of external and internal oblique, transversus and aponeurosis abdominus combone to form the rectus sheath which then forms the linea alba

138
Q

what forms the inguinal ligament

A

the inferior edge of the external oblique aponeurosis

139
Q

what does the inguinal ligament run between

A

ASIS and pubic tubercle

140
Q

what is the pyramidalis

A

a small triangular muscle which arises from the anterior surface of the pubis and is inserted into the linea alba

141
Q

what is the path of the fundus during pregnancy

A

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
Q

when does the symphysiofundal height n cm equal the gestation

A

from 20 weeks onwards +/- 3 cmq

143
Q

what does a midline verticle incision go through

A

the linea alba- relatively avascular

144
Q

what structures are incised in a C section

A 
skin 
superficial fascia 
rectus sheath (only anterior layer)
rectus muscles separated not incised 
parietal and visceral peritoneum incised 
uterus and amniotic sac
145
Q

why do you need to suture the rectus sheath after c section

A

to prevent hernia formation

146
Q

what is the rectus sheath

A

strong fibrous structure, which encloses rectus abdominis and is created from the aponeuroses of external oblique, internal oblique and transversus abdominis

147
Q

what artery is at risk in laparoscopy

A

inferior epigastric artery

148
Q

what is the sruface marking of the inferior epigastric artery

A

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
Q

what is the inferior epigastric artery a branch of

A

the external iliac artery

150
Q

what is the path of the external iliac artery

A

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
Q

what is the neurovascular supply to the abdo wall

A

The intercostal neurovascular bundles between ribs 7 to 12, the subcostal bundle inferior to rib 12, and branches of the L1 spinal nerve

152
Q

what is the position of the ovary

A

lies against pelvic wall in ovarian fossa

ureter and internal iliac vessels run behind it, obturator nerve runs lateral

153
Q

what suspends the uterus

A

uterine arteries

154
Q

what are the uterine arteries branches of

A

internal iliac

155
Q

what supplies the fundus

A

ovarian arteries

156
Q

what is the venous drainage of the uteris

A

internal iliac and ovarian veins

157
Q

where does the ovarian artery leave the aorta

A

L2

158
Q

what suspends the ovaries

A

broad ligament (double fold of peritoneum)

159
Q

what fornix is the pouch of douglas close to

A

posterior fornix of vagina

160
Q

what is the mesosalpinx

A

part of broad ligament that stretches from ovary to fallopian tube

161
Q

are the ovaries intra or retroperitoneal

A

intra- peritoneum combines with ovary wall

162
Q

how does ovarian cancer spread

A

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
Q

when does bladder rise out of pelvis

A

when full or in labour

lift peritoneum off anterior abdo wall

164
Q

what is the course of pelvic lymph drainage

A

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
Q

where are the inguinal lymph nodes

A

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
Q

what drains to the inguinal nodes

A

superficial elements of the perineum

167
Q

whats nodes does the rectum drain to

A

sacral and internal iliac

168
Q

whats nodes does the anal canal drain to

A

internal iliac, but lower canal to superficial inguinal

169
Q

whats nodes does the bladder drain to

A

internal and external iliac

170
Q

whats nodes does the Prostate and proximal urethra (male and female) drain to

A

internal iliac

171
Q

whats nodes does the Distal, penile urethra, penis and clitoris drain to

A

superficial inguinal

172
Q

what nodes does the testes and ovaries drain to

A

para aortic

173
Q

what nodes does the Uterine tube, uterine fundus and upper uterine body drain to

A

para aortic

174
Q

what nodes does the Lower uterus, cervix and proximal vagina drain to

A

internal and external iliac

sacral

175
Q

what nodes does the distal vagina and vulva drain to

A

superficial inguinal

176
Q

when is the ureter at risk

A

when ligating uterine artery
in ovarian fossa -adhesions/ endometriosis
colon surgery- passes on post abdo wall under sup and inf mesenteric vessels

177
Q

what is the nerve supply of the detrusor muscle

A

parasympathetic nerves derived from the pelvic splanchnics S2,3,4

178
Q

what supplies the urethral smooth muscle

A

sympathetic nerves T10-L2

towards bladder and urethra is hypogastric nerves

179
Q

what supplies the striated urethral sphincter muscle

A

branches of the pudendal S2,3,4

180
Q

what nerve influence allows for storage of urine

A

sympathetic
tone in urethral sphincter and levator ani
(overrides para to detrusor muscle)

181
Q

what nervous influences allow urine voiding

A

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
Q

what is the role of the male internal urethral sphincter

A

prevents back flow of semen into bladder at ejaculation

183
Q

what is the vulva

A

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
Q

what part of levator ani does the vagina pass through

A

pubovaginalis

185
Q

what muscle type lines the vagina

A

smooth

186
Q

why is the lateral fornix important

A

larger
distensible- can hide foreign bodies
directly related to pouch of douglas

187
Q

in females what does the external urethral sphincter encircle

A

urethra and vagina

188
Q

what supplies sensation to the vaginal and urethra

A

pudendal

189
Q

what is the blood supply to the vagina and urethra

A

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
Q

what is the lymph drainage of the vagina and urethra

A

upper vagina and urethra is to the iliac nodes and the lower to the superficial inguinal nodes

191
Q

what muscle overlies the bulb of erectile tissue in female

A

bulbospongiosus

192
Q

what muscle overlies the crura in females

A

ischiocavernosus

193
Q

what is the membranous urethra in males

A

part going through urogenital diaphragm

194
Q

what does the spongy urethra go though

A

bulb of penis and carpus spongiosum

195
Q

what do the bulbourethral ducts do

A

feed lubricating mucous from the bulbourethral gland into the urethra at the bulb of the penis

196
Q

what contracts in males to expel the last bit of wee

A

bulbospongiosus muscle (surrounds the bulb)

197
Q

what blood supply to the male urethra

A

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
Q

what lymph drainage is the male urethra

A

internal iliac

199
Q

what is the lymph and vascular Supply to: the Female Vulva and Labia; the Male Penis and
Scrotum

A

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
Q

lymph drainage of labia

A

iliac

201
Q

what is the nerve supply of the penis

A

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
Q

what is the nerve supply of the clitoris

A

dorsal nerve of the clitoris and perineal branches of the pudendal nerve

203
Q

what is a greater vestibular gland

A

bartholins glands

204
Q

what are the borders of the urogenital triangle

A

pubic symphysis
ischiopubic ramus
ischial tuberosity
tranverse perineal muscle

205
Q

what are the borders of the ischioanal triangle

A

transverse perineal
ischial tuberosity
sacrotunerous ligamemt
coccyx

206
Q

what are the normal lengths of male and female urethras

A

f- 4-5cm

m- 18-22cm

207
Q

what supports the cervix and upper vagina

A

Uterosacral, transverse cervical and pubocervical ligaments

208
Q

what supports the middle vagina

A

pelvic fascia

209
Q

what supports the lower vagina

A

levator ani and perineal body

210
Q

what do the broad and round ligaments maintain

A

anteversion and anteflexion

211
Q

what ligaments attach to the uterus

A

round, ovarian, uterosacral, transverse cervical, pubocervical, broad

212
Q

what do the sarcotuberous and sacrospinous ligaments maintain

A

prevents body weight tilting lower sacrum up and backwards

213
Q

what can loss of pelvic fascia in the lower third of the vagina cause

A

cytocele and rectocele

214
Q

what does the levator ani arise from

A

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
Q

what inserts into the anococcygeal ligament (thickening of levator ani)

A

Iliococcygeus and pubococcygeus

216
Q

what is the role of the obturator internus

A

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
Q

what can damage pelvic floor support

A

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
Q

what are the proximal and distal attachments of coccygeus

A

p- ischial spin

d- Inferior end of sacrum and coccyx

219
Q

what are the proximal and distal attachments of puborectalis

A

p-body of pubis

d-perineal body

220
Q

what are the proximal and distal attachments of pubococcygeus

A

p-Pubic bone, Tendinous arch of obturator fascia

d- Vagina, perineal body, rectum, coccyx

221
Q

what are the proximal and distal attachments of iliococcygeus

A

p-Ischial spine and tendinous arch

d- Perineal body, coccyx

222
Q

what is the role of pubococcygeus

A

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
Q

what is the role of iliococcygeus

A

compresses the urethra, vagina, and anus; elevates the recto-anal junction

224
Q

what is the nerve supply to the levator ani

A

Nerve to levator ani (S4), along with branches from the pudendal nerve, S2, 3, 4.

225
Q

what passes behind the sacrospinous ligament

A

pudendal nerve, artery and vein (lie within the pudendal canal)

226
Q

what forms the ischioanal fossa

A

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
Q

what passes through the ischioanal fossa

A

pudendal neurovascular bundle

inferior rectal neurovascular bundle

228
Q

what is the clinical relevance of the ischioanal fossa

A

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
Q

what must be identified to perform a pudendal nerve block

A

ischial spine (anesthetic solution is pumped around the spine in order to reach the nerve, which hooks around the structure)

230
Q

what is at risk when inserting a trochar through obturator membrane

A

obturator neurovascular bundle (goes through obturator canal)

231
Q

where does the breast and nipple sit on the chest

A

breast:
- between ribs 2-6

nipple:
- T4
- 4th intercostal space

232
Q

what muscles does the breast sit on

A

most pec major

some serratus anterior and superior aspect of the external oblique

233
Q

what is between the breast on pec major - what is the clinical importance

A

retromammary space

allows breast to move relative to muscle

234
Q

what are the groups of lymph nodes within the axilla

A 
APICAL: 
A- anterior
P-posterior
I-infraclavicular
C-central
A-apical
L-lateral
235
Q

what does a fixed lump in the breast suggest

A

invasion into retromammary space and muscle

236
Q

what is the lymph drainage of the breast

A

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
Q

what are the division of the axillary lymph nodes

A

level 1- inferior/lateral
to pec major
level 2- posterior to pec major
level 3- superior/ medial to pec major

238
Q

what level of nodes are the breast sentinel nodes

A

1

239
Q

what changes happen to the breast in pregnancy and post menopause

A

pregnancy- lobules enlarge, proliferate and start lactating

PM- loose fibrofatty tissue, become less dense, loose elasticity of collagen

240
Q

why can prolactinoma cause amenorrhea

A

reduces oestrogen

241
Q

drug for prolactinoma

A

cabergoline (dopamine agonist)

242
Q

what angle should a vaginal speculum be inserted in order to view the cervix

A

45 degree downwards, towards back

243
Q

what is the pouch of douglas

A

rectouterine pouch

lower part in standing female

244
Q

what arteries and veins supply the uterus

A

uterine (from internal iliac) and ovarian (supply the fundus) arteries anastomose together
ovarian and internal iliac veins

245
Q

what are the features of a threatened miscarriage and what would you see on USS

A

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

Reproduction (51 decks)

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