anatomy Flashcards
(100 cards)
1
Q
What is anatomy?
A
- science of structure revealed by dissection and imaging
- i.e. microscopic, cytology, histology etc…
2
Q
What is physiology?
A
- science of body functions, use normal adult physiology
- i.e. cell, systems, exercise, neuro, reproductive, endocrine, cardiovascular, respiratory, renal etc…
3
Q
What is anatomical position?
A
- standing upright head level, eyes forward
- feet flat on the floor
- arms at the sides, palms turned forward
4
Q
What is prone?
Hint - face is protected
A
if body is lying face down
5
Q
What is supine?
A
if body is lying face up
6
Q
What are regional terms (medial, lateral, superior, inferior)?
A
used to precisely locate one part of body relative to another → reduces lengths of descriptions
7
Q
What are planes in anatomy (sagittal, midsagittal, parasagittal)?
A
imaginary flat surfaces used to divide the body/organs into definite areas
8
Q
What are sections in anatomy and how are they named?
A
- flat surfaces resulting from cuts through body structures
- named according to plane on which the cut is made
9
Q
What are body cavities? provide examples.
Hint - spaces which do what for organs?
A
- spaces within the body which help protect, separate and support internal organs
- i.e. dorsal cavity lined by meninges, cranial cavity, vertebral cavity, thoracic cavity divided by the mediastinum, pleural cavities enclose lungs, pericardial cavity surrounds heart
10
Q
Which two portions is the abdominopelvic cavity divided into and which viscera can be found contained in each one?
(Hint - superior and inferior → superior = SSPLGSL and inferior = BIL)
A
- superior abdominal cavity → stomach, spleen, pancreas, liver, gallbladder, small and large intestines
- inferior pelvic cavity → bladder, portions of the large intestine and internal reproductive structures
11
Q
What is:
a) palpitation? provide examples.
b) auscultation? provide examples.
c) percussion? provide examples.
A
a) examiner feels body surfaces with hands i.e. pulse and HR
b) examiner listens to body sounds to evaluate the functioning of certain organs i.e. listening to lungs/heart with a stethoscope
c) examiner taps on body surface with fingertips and listens to resulting echo i.e. looking for masses (dull) or air (hyper-resonant)
12
Q
What is medical imaging and what does it allow?
A
- specialised branch of anatomy and physiology for diagnosis of some disorders
- physicians to view inside body to observe whether anatomy is present → to diagnose disease
13
Q
Which six analysis techniques, other than medical imaging, are also commonly-used and when is each one required?
(Hint - DAS my PET)
A
- conventional radiography - a single burst of x-rays to produce 2-D image on film with a poor resolution of soft tissues (CXR or AXR) → osteology
- computed tomography/CT scan - moving x-ray beam to produce 3D video monitor of a cross-section through body → soft tissue detail
- digital subtraction angiography (DSA) - radiopaque material injected into blood vessels → image before and after compared by computer
- ultrasound scan (USS) - safe method using a hand-held device which emits high-frequency sound waves so sonogram displayed → foetal ultrasound, examination of pelvic and abdominal organs, heart + blood flow
- magnetic resonance imaging (MRI) - body exposed to protons aligned in a high-energy magnetic field to create a video image of fine detail within soft tissues → can’t use on patients with metal in their body
- positron-emission tomography (PET) - positively-charged substance injected, collides with negatively-charged electrons in tissues releasing γ rays detected by a camera and displayed on a computer
14
Q
Which bones make up the pelvic girdle and which fuse to form the L + R innominate bones or coxae?
A
- ilium x 2
- ischium x 2
- pubis x 2
- sacrum
- (coccyx)
- ilium, ischium and pubis fuse
15
Q
For the pelvic cavity, what is the:
a) superior border?
b) inferior border?
c) lateral border?
d) anterior border?
e) posterior border?
(Hint - SILAP and I DOPP)
A
a) pelvic inlet (abdominal cavity)
b) pelvic diaphragm (perineum below)
c) (hip bones), obturator internus muscle
d) pubic bones/symphysis
e) piriformis muscle and sacrum (+ coccyx)
16
Q
Which two structures form the roof of the pelvic cavity?
Hint - PA and L
A
• promontory and ala of sacrum
• L + R linea terminalis:
- arcuate line, pectineal line (pectin pubis) and pubic crest → marks the plane of the pelvic inlet
17
Q
What does the pelvic inlet separate?
A
true (greater) pelvis pelvis from the false (lesser) pelvis
18
Q
What is a true pelvis and a false pelvis?
A
- true → short, curved canal which contains the pelvicinlet
- false → supports intestines and transmits part of weight to anterior wall of the abdomen
19
Q
What are the pelvic diaphragm muscles?
Hint - IL
A
- ischiococcygeus (between ischial spine and sacrum)
- levator ani (muscular sheet)
20
Q
What are the three parts of the levator ani muscle and what is its role in the pelvis?
(Hint - prefix always pubo/ilio and suffix coccygeus/rectalis + role is to do with bladder 300ml even when sneezing)
A
• made up of: - iliococcygeus - pubococcygeus - puborectalis • assists in maintaining continence (micturition reflex) + resisting pressure during coughing or sneezing → must relax allow urination + defecation
21
Q
What are the differences in the male and female pelvis in terms of the:
a) sacrum?
b) coccyx?
c) greater sciatic notch?
d) pelvic inlet?
e) pelvic outlet?
A
a)
• M - narrow and longer with sacral promontory more ventral
• F - wider and shorter with sacral curvature is accentuated
b)
• M - less movable + curves ventrally
• F - more movable + straighter
c)
• M - narrow and deep
• F - wide and shallow
d)
• M - narrow → heart-shaped
• F - wider → oval from side to side
e)
• M - narrower → ischial tuberosities longer, sharper + point more medially
• F - wider → ischial tuberosities shorter, farther apart, and everted
22
Q
What are the three types of pelvic ligaments?
Hint - FAP
A
- articular → fibrous tissue joining bone-to-bone
- peritoneal → folds of peritoneal membrane
- foetal remnants → remains of tubular structures
23
Q
What are the different articular ligaments of the pelvis and do they join at the joints or elsewhere?
(Hint - LSPs and SIS → ic and st)
A
• at joints: - lumbosacral (iliolumbar + lumbosacral) ligaments - sacrococcygeal ligaments - sacroiliac ligaments - pubic (symphysis) ligaments • elsewhere - inguinal ligaments - sacrospinous ligaments - sacrotuberous ligaments
24
Q
What do both the sacrospinous and sacrotuberous ligaments create and prevent?
A
- create foramina of greater and lesser sciatic notches
- prevent rotation of ilium wrt. sacrum
25
Which three structures pass through pelvic foramina?
| Hint glo Fs
- greater sciatic foramen
- lesser sciatic foramen
- obturator foramen
26
What is the peritoneum of the pelvis and which types of tissue are found here?
- a serous membrane lining abdominopelvic cavity
| - mesothelial + areolar CT, over organs in pelvic cavity
27
What type of organs are most pelvic organs and what are the exceptions to this?
- sub/infra-peritoneal
- exception → uterine tubes are intraperitoneal + suspended by a mesentery (ovaries also suspended by a mesentery but not covered in regular peritoneum)
28
What are the three peritoneal reflections and are they are found in males or females?
- rectouterine pouch of Douglas: between rectum and uterus (F)
- uterovesical pouch: between bladder and uterus (F) → sometimes called vesicouterine excavation
- rectovesical pouch: between bladder and rectum (M)
29
What can drain into peritoneal pouches and how can this be clinically dealt with?
- pus and pathological fluid can drain into these pouches
| - by drainage of pus in the peritoneal cavity
30
Name the 4 female reproductive organs and their numbers.
1. uterus
2. uterine tubes x2
3. ovaries x2
4. vagina
31
What is the uterus and what does the cervix allow?
- an external environment within the body where a foetus develops
- passage of various substances between uterus and vagina
32
What are the three main parts of the uterus?
- fundus (above the level of entry of uterine tubes)
- body (flattened anteroposteriorly, stretchy + muscular)
- cervix (opens into vagina and more muscular than other structures)
33
Why must the cervix be kept tight during pregnancy?
to protect the foetus from infection and keep it in place
34
What are the three different layers of the uterus?
| Hint -metrium = uterus
- epimetrium/perimetrium → derived from the peritoneum, a thin layer
- myometrium → SM and a thick layer
- endometrium → inner mucous coat which sheds in menses
35
What are the different structural supports of the uterus?
| Hint - pd, the silver membrane and BRUC ligaments with the widest having 3 meso parts
- pelvic diaphragm (active support)
- perineal body
- broad ligament (double layer of peritoneum):
• mesometrium: mesentery of uterus
• mesosalpinx: mesentery of uterine tube
• mesovarium: mesentery of ovary
- uterosacral ligament (cervix to sacrum)
- cardinal ligament (cervix to ischial spine)
- round ligament
36
What is the mesentery used for in the ovaries, which structures surround the ovary and which structures branch off from the uterine tube?
- thick muscular layer used for support
- fimbriae
- blood vessels
37
```
State what each of the following mean:
a) anteverted
b) retroverted
(Hint -
ante = FRONT
- retro = BACK
- version = angle between cervix and vagina
- flexed = angle between cervix and uterus)
```
a) axis of cervix tilted forwards in relation to vaginal axis
b) axis of cervix tilted back in relation to the vaginal axis
38
What angle of the vagina, cervix and uterus is shown when the:
a) vagina, cervix and uterus are tilted backwards?
b) head vagina, cervix and uterus are twisted backwards onto rectum?
c) vagina, cervix and uterus are twisted forward?
d) vagina, cervix and uterus are tilted forward around 80°?
a) retroverted
b) retroflexed
c) anteflexed
d) anteverted
39
How does the uterus change position as the bladder and rectum fill?
(Hint - rectouterine pouch and ureterovesical pouch with vesico less twisted forwards)
- as rectum fills → its pressed forwards onto uterus
| - as bladder fills → it pushes up on uterus, less anteflexed
40
What is meany by each anatomical variant of uterus positioning in terms of vagina position and version?
a) anteflexed
b) anteversion
c) retroflexed
d) retroversion
(Hint - eversion on anything which ends in version)
a) bending towards front → no eversion, not bent here
b) towards the front → eversion = not flexed
c) bending towards the back → retroversion towards the back
d) towards the back → eversion = not flexed
41
What is uterine prolapse and how can it be fixed?
| Hint - U → CV
- the weakening of the pelvic floor and ligaments caused by repeated childbirth → uterus drops down to cervix or vagina
- fixed by stitching it back up
42
What are fibroids or uterine leiomyomas, their five symptoms and how are they supplied?
(Hint - symptoms to do with fluid transmission, types of pain and IBS, what are tumours sensitive to?)
- benign tumours originating from myometrium (common in middle-late reproductive years)
- symptoms if large: heavy painful menstruation, painful intercourse, back pain (pushing on ligaments), abdominal discomfort and increased urinary frequency (smaller bladder volume) → usually cyclic
- tumours are hormone-sensitive + fibroids are supplied by uterine artery
43
How can fibroids be treated?
| Hint - puhmh
- pharmacological intervention to reduce oestrogen
- uterine artery embolization to reduce blood supply to fibroids (minimally-invasive)
- hysteroscopic resection of fibroids using a resectoscope
- myomectomy (surgical fibroid removal) → laparoscopic (keyhole) hysteroscopic or open laparotomy (via camera)
- hysterectomy (uterus removal) → laparoscopic, transvaginal or open laparotomy
(see notes for diagrams)
44
What are uterine/fallopian tubes and what are their three main segments?
(Hint - position of ovaries, IAI and then describe)
• structures which project laterally from the uterus (also called oviducts/salpinges)
• segments:
- isthmus → narrow, joins uterus
- ampulla → more dilated, lateral portion
- infundibulum → surrounded by fimbriae
45
What does each fallopian tube open into and where within the uterus are eggs caught by and received from?
(Hint - into a double-layered something, caught by the little bristles of the brush, received from the actual brush ball)
- into the peritoneal cavity at their distal ostium (opening) to the infundibulum (where internal and external environment meet)
- caught by fimbriae
- received from ovaries
46
What does the uterine artery pass above, when is this structure at risk of damage and how often does this occur?
- the ureter
- during pelvic surgery as the two are so close and look so similar (uterine artery to be cut) → especially in hysterectomies + ovariectomies
- in 2% of hysterectomies (accidentally clamped, ligated or transected)
47
What does the round ligament pass down, what is it an embryological remnant of and how does it embryologically develop?
- the inguinal canal
- embryological remnant of the vestige of the female gubernaculum
• fibrous cord connecting ovary + primordial uterus to the labium majora → upper part becomes ovarian ligament and lower part becomes round ligament
48
What does the round ligament maintain?
anteversion in pregnancy (tilting uterus forward so foetus has sufficient space to grow upwards)
49
What does the male gubernaculum draw through the inguinal canal?
the testes
50
What is the ovary and what is it suspended by?
| Hint - a what f sex organ and a suspending ligament + a particular type of mesentery
- almond-shaped and sized female gonad, site of ova development and endocrine gland (hormone-production)
• suspended by:
- the mesovarium (specialised mesentery covering ovaries which hold everything in place)
- suspensory ligament of ovary (lateral broad ligament which carries blood vessels)
51
What is the ovary connected to the uterus by, what is it covered by in early life and what happens to the ovary with age?
- ovarian ligament
- covered by layer of cuboidal cells in early life
- shrinks and becomes pitted
52
Describe the blood supply to the ovaries and uterus using the following diagram.
1. L + R ovarian arteries originate from abdominal aorta at L2
2. once the arteries have reached the pelvic brim they:
- cross over external iliac arteries
- enter suspensory ligaments of ovaries
3. at ampulla → split into ovarian + tubal branches, supplying both ovaries and uterine tubes
4. these branches anastamose (cross over) with branches of uterine artery originating from internal iliac artery
53
What does the cross-connection in the blood supply to the ovaries and uterus mean?
that if one branches blood supply is cut off, can still be supplied due to other branch
54
What is uterine artery embolisation and what are the possible issues with this?
- the process used to treat/remove fibroids
- issue:
- particles injected into uterine artery to block the blood supply to fibroids could migrate into ovaries blocking parts of ovarian tissue → possible infertility
55
What is the obturator nerve lateral to and what is the only separation of these two structures?
- lateral to the ovary
| - separation by the peritoneum
56
What can ovarian growths do to the obturator nerve and what can this cause?
- can compress obturator nerve and cause tumours + cysts
| - causes pain and weakness of medial thigh → first symptom of an ovarian mass
57
What are the vagina, cervix and fornices in relation to one another?
- flattened muscular tube which runs upwards and backwards from its opening in perineum
- cervix protrudes into upper part of the vagina (vagina vault) which creates a ‘gutter’ - the fornix
- fornices = anterior, lateral and posterior
58
What are the three main roles of the vagina in females?
| Hint - think at each different stage
- copulatory organ = sexual intercourse
- birth canal
- passageway for menstruation
59
What does a digital vaginal examination with a bimanual approach involve and when may a rectovaginal examination be more appropriate?
(Hint - u anterior, A lateral and A posteriorly → think the rectum is at the back of the reproductive system)
- cervix, os, fornices can be palpated using 2nd and 3rd fingers
• uterus palpated anteriorly
• adnexa palpated via lateral fornix
• abnormalities in pouch of Douglas palpated posteriorly
- rectovaginal examination → improved palpation of posterior structures
60
What is the route of the male peritoneum in forming the rectovesical pouch and what can collect in the roof of the retropubic space?
(Hint - antabd wall → ps → f of b → b of b → r → rvp)
- descends on anterior abdominal wall → pubic symphysis → fundus of bladder (roof of retropubic space) → descends + folds to from base of bladder → ascends over rectum → forms rectovesical pouch
- roof of retropubic space → can collect matter from RTA injures or perforation of bladder here
61
How can abscesses in or near the male peritoneum be drained?
| Hint - on the opposite side of the rectum
transrectally
62
The male reproductive organs is a series of tubes which run where?
(Hint - PAbdPelvP)
perineum → via abdomen → pelvic cavity → (back to) perineum
63
What are the internal and external male genitalia?
| Hint - internal is BEST PED + external is USP
```
• internal:
- testes (x2) postnatal position external
- epididymies (x2) postnatal position external
- ductus deferentes/vasa deferentia (x2)
- seminal vesicles (x2)
- ejaculatory ducts (x2)
- prostate (x1)
- bulbourethral (Cowper) glands (x2)
• external: urethra, scrotum, penis
```
64
State the structures in the route through the internal male genitalia starting from the testes.
(Hint - testes > weewee > p ball > pu > mu > su)
testes > urinary bladder > prostate > prostatic urethra > membranous urethra > spongy (penile) urethra
65
What is the prostate?
| Hint - where which two tracts meet?
where the urinary and reproductive tract merge
66
What do the seminal vesicles merge together to form?
the ejaculatory duct
67
What does the ejaculatory duct pass into and merges with?
- the prostate
| - the urethra
68
What are the testes and how do the left and right compare?
| Hint - male version of the two Os and the LHS is always odd
- paired male gonads homologous to ovaries
| - left testis is lower than right
69
What do the ovoid glands produce, where are they suspended and by what?
- sperm + hormones (testosterone, androgens)
- suspended in scrotum (controlling temp outside of the body)
- by spermatic cord (vasa deferens are a part of this, contains blood vessels; not interchangable)
70
What is the tunica albuginea and what is the epididymis?
| Hint - surface for what function, what type of ridge?
- the tough fibrous outer surface for protection
| - an elongated posterolateral ridge
71
What is the tunica vaginalis in males and what is it called in females?
- part of the peritoneum → a double-layered membranous sac which surrounds testes, a closed-off parietal and visceral layer
- processus vaginalis in females
72
What is the route of sperm in the male reproductive system?
| Hint - st → tr → rt → ed → e → s → d → s
seminiferous tubules of testes (production) → tubuli recti → rete testis channels → efferent ductules → epididymis (head > body > tail) → single, long coiled duct → merges into ductus (vas) deferens → (main component of) spermatic cord
73
What is the ductus (vas) deferens?
| Hint - tubes all about sperm passage
paired, muscular tubes from which tubule conveys sperm from epididymis to ejaculatory duct
74
What route is taken by the ductus (vas) deferens?
| Hint - ic → p of pw → posterior b → a → sv → eds → pu
inguinal canal → peritoneum of pelvic wall → posterior bladder → ampullae → (join) seminal vesicles → ejaculatory ducts → (open into) prostatic urethra
75
What are seminal vesicles?
| Hint - how long and between which two organs, what do they store and how do they connect to form prostatic urethra
- elongated, paired structures (5cm long) which lie between fundus of bladder and rectum
- do not store sperm → secrete alkaline, fructose-rich fluid as energy-source for sperm
- ducts join ductus deferentes → form paired ejaculatory ducts → open into prostatic urethra
76
What is the prostate, where does it lie, which part of the male urethra runs through it and what does it produce?
- firm, walnut-sized accessory gland
- lies below neck of bladder
- prostatic part of male urethra runs through it
- produces milky fluid that aids sperm motility
(PSA – prostate serum antigen)
77
What do prostatic ducts open into?
| Hint - 3x posterior
prostatic (urethral) sinuses on posterior wall of prostatic urethra
78
What does the seminal colliculus (bulge) contain?
| Hint - P and u sounds like ventricle + E ducts
prostatic utricle + ejaculatory ducts
79
What is the prostatic utricle?
| Hint - like a dodgy nose
a ridged indentured structure which is elevated to the urethral crest (can open)
80
What is the prostate covered by, contain and surrounded by?
| Hint - fibre, pp AVNs, a case
- a fibrous capsule
- all prostatic plexuses of veins and nerves
- a prostatic sheath
81
What does the apex of the testes have and what is it used for?
(Hint - an external door and what Keren is always on about)
- external urethral sphincter
| - used to stop involuntary urination
82
What is the arterial supply to the prostate and seminal vesicles?
(Hint - IVA)
branches of inferior vesical artery (branch of internal iliac artery)
83
What is meant by the base and apex?
- base = top
| - apex = bottom
84
What is the prostate homologous to in females?
| Hint - a skunk gland
the skene’s gland in females
85
What is the route taken by milky fluid through the prostate?
| Hint - ducts → sc → external s
- through openings of ducts
- mixes with seminal colliculus
- then, leaves via external urethral sphincter
86
Where might we need to palpate the prostate gland and what would be looked at?
- palpating prostate gland - important in detecting prostate tumours as the prostate enlarges → look at texture + size
87
What are the bulbourethral (cowper) glands?
- pea-sized, paired glands posterolateral to membranous urethra
- embedded in external urethral sphincter
88
What is the function of the bulbourethral (cowper) glands?
| Hint - around
- pass through perineal membrane with membranous urethra
• open through minute apertures in proximal part of spongy (penile) urethra - bulb of penis
• secrete mucoid fluid/pre-ejaculate during sexual arousal
89
For each gland, for the % of semen produced, state the content:
a) testes (2-5%)
b) seminal vesicles (65-75%)
c) prostate (25-30%)
d) bulboerethral glands (1-5%)
a) sperm (000s of million per ejaculate)
b) yellowish, alkaline, fructose-rich fluid providing energy for sperm
c) thin milky white alkaline fluid aiding sperm mobility containing PSA (prostate-specific antigens), acid phosphatase, zinc and more
d) clear fluid (pre-ejaculate), rich in mucus and galactose that provides a suitable matrix for sperm to travel in
90
What is meant by the descent of the testes?
when they are slowly pulled down and outwards
91
What is a vasectomy and what does it result in?
| Hint - ‘tomy’ means ‘surgical removal of’
- removing a small piece of vas deferens
| - sperm can no longer pass through this tube → cannot enter penis (unexpelled sperm degenerates within the epididymis)
92
What can an enlarged prostate result in and lead to?
- can impinge on the bladder and urethra
| - can change the direction of urine so much it is blocked from travelling through the urethra
93
Where in the prostate can hyperplasia (– too many cells) occur and what can this result in?
(Hint - blockage)
in central prostate → causes it to initially block urethra as this is central
94
Which symptoms can an enlarged prostate lead to and what does this result in?
(Hint - a group of symptoms + weewee)
- lower urinary tract symptoms (LUTS) - as prostate impinges on bladder
- causes individual to feel increased urgency + frequency
95
What is the relationship between incidence of benign prostatic hyperplasia and LUTS with age?
- linked with one other → as one increases so does the other (very common in elder men)
- graphs show you can have small swelling without producing symptoms
96
What is Transurethral resection of prostate (TURP) and how does it work?
(Hint - to remove something using a 'oscope' and make asymptomatic)
- procedure to remove some prostatic tissue
- insert resectoscope through urethra to prostate
- removing tissue removes pressure on bladder and urethra → reducing symptoms
97
What is cancer of the prostate (not benign)?
- most common cancer in males
| - slow-growing may metastasize to vertebral column and pelvis via venous plexuses and lymphatic system
98
How can we diagnose cancer of the prostate (not benign)?
| Hint - dr DRE tests PSA because his patients TRUSt him and his BIOSPY/IMAGING
- DRE (digital rectal examination)
- PSA (blood test)
- TRUS – transrectal ultrasound
- biopsy and imaging
99
How can we treat cancer of the prostate (not benign)?
| Hint - sscrh
- surveillance (may not metastasise)
- surgery
- chemotherapy
- radiation
- hormone treatment
100
What are the hallmarks of stages I-IV of prostate cancer?
- stage I - small cancer restricted to one area of prostate
- stage II - cancer spread to various areas of the prostate
- stage III - cancer spreads into the potential space, wall of the bladder, seminal vesicles
- stage IV - metastasis of cancer, walls of the rectum, lymph nodes – access to rest of the body
