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Fellows 2021! > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Posterior division of the internal iliac

A

I LOVE SEX

Iliolumbar
Lateral sacral
Superior gluteal

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2
Q

Anterior division of the internal iliac

A 
Obturator
Umbilical
Superior vesical
Inferior vesical
Internal pudendal (inferior rectal)
Inferior gluteal
Middle rectal
Uterine
Vaginal
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3
Q

Vascular supply of the ureter

A

Renal, gonadal, aorta, common iliac, internal iliac, superior vesical, uterine, middle rectal, vaginal, inferior vesical (lots of collateral blood flow)

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4
Q

Pudendal artery path

A

Supplies perineum.
Exits pelvis via greater sciatic foramen caudal to piriformis. Reenters pelvis through lesser sciatic foramen through Alcock’s canal.

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5
Q

Midline avascular spaces

A

Retropubic (Space of Retzius)
Vesicovaginal
Rectovaginal (Pouch of Douglas)
Presacral

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6
Q

Paired lateral avascular spaces

A

Paravesical
Pararectal

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7
Q

Space of Retzius contents

A

Plexus of Santorini
Cooper’s ligament (bilateral)
Dorsal clitoral artery (midline)
Obturator bundle (laterally)

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8
Q

Borders of the Space of Retzius

A 
Pubic symphysis (anterior)
Obturator internus (bilateral)
Bladder (posterior
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9
Q

Vesicovaginal space borders

A 
Bladder adventitia (anterior)
Bladder pillars (bilateral)
Vaginal/endopelvic fascia (posterior)
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10
Q

Rectovaginal Space (Pouch of Douglas) borders

A

Vagina (anterior)
Rectum (posterior)
Uterosacral ligaments (bilateral)

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11
Q

Significance of Pouch of Douglas

A

Extension of the peritoneum covering surfaces of vagina and rectum. Lowest point in the pelvis - dependent space for ascites and spread of disease.

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12
Q

Presacral Space borders

A

Rectum (anterior)
Sacrum (posterior)
Uterosacral ligaments/ureter (bilateral)
Waldeyer’s fascia and levator ani (inferior, 3-5cm proximal to anorectal junction)

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13
Q

Presacral space contents

A

Middle sacral artery

Hypogastric plexus

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14
Q

Paravesical space borders

A 
Pubic symphysis (anterior)
Cardinal ligaments (posterior)
External iliac vein/obturator muscle (lateral)
Umbilical artery (medial)
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15
Q

Paravesical space contents

A

Obturator nerve

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16
Q

Pararectal space borders

A

Cardinal ligaments (anterior)
Sacrum (posterior)
Internal iliac artery (lateral)
Rectum/ureter (medial)

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17
Q

Blood supply of the small bowel

A

SMA, middle colic, arcades and straight arteries

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18
Q

Blood supply of the large bowel

A

Marginal artery of Drummond (anastomotic loop with SMA and IMA)

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19
Q

Bowel most at risk for watershed injury

A

Left colic/splenic flexure (least anastamoses)

20
Q

Celiac trunk blood supply and branches

A

Blood supply to foregut and spleen

Branches: left gastric, splenic, common hepatic

21
Q

SMA blood supply and branches

A

Blood supply to midgut

Middle and right colic, inferior pancreaticoduodenal, jejunal branches, ileal branches, ileocolic

22
Q

IMA blood supply and branches

A

Blood supply to hindgut

Left colic, sigmoid, superior rectal

23
Q

Inferior phrenic arteries supply?

A

Blood supply to diaphragm

24
Q

Median sacral artery

A

Blood supply to sacrum - UNPAIRED

25
Risks of diaphragm stripping/dissection
Hemorrhage (IVC, hepatic vasculature), pneumothorax, hepatic injury, phrenic nerve injury (diaphragm paralysis)
26
Mobilizing the Spleen - what needs to be cut?
``` Splenic artery and vein (splenic hilum) Gastrosplenic ligament Splenocolic ligament Splenorenal ligament Phrenocolic ligament VERY proximal to tail of pancreas ```
27
Ligaments of the liver
Falciform Triangular (right and left) Coronary Ligamentum teres hepatis (obliterated umbilical vein)
28
Foramen of Winslow
``` Omental foramen (lesser omentum, superior to stomach) Allows access to porta hepatis ```
29
Greater and lesser omental sac
Greater - below stomach, anterior to bowel | Lesser - posterior and superior to stomach
30
Morrison's Pouch
Hepatorenal recess, potential space between liver and right kidney Lowest point in RUQ when supine, frequent site of metastasis from ovarian or appendiceal cancer
31
Hepatorenal Recess
Morrison's Pouch, potential space between liver and right kidney Lowest point in RUQ when supine, frequent site of metastasis from ovarian or appendiceal cancer
32
Gerota's fascia
Renal fascia
33
Ligament of Treitz
Suspensory ligament of the duodenum | Suspends the duodenojejunal junction to the Celiac trunk
34
White Line of Toldt
Lateral reflection of posterior parietal peritoneum over the mesentery of the ascending and descending colon. Avascular plane for incision, mobilization of colon.
35
Lumbar plexus nerve roots, and what nerves does it give rise to?
L1-4 | Genitofemoral, lateral femoral cutaneous, femoral
36
Genitofemoral nerve roots, function, and injury
L1-2 Sensory to upper anterior thigh, mons, and labia majora Injury via retractor placement or transection
37
Lateral femoral cutaneous nerve roots, function, injury
L2-3 Sensory to anterior lateral thigh Injury via compression due to hip hyperflexion
38
Femoral nerve roots, function, injury
L3-4 Motor function to knee extensors, sensory to upper inner thigh Injury via retractor placement, positioning intraop, child birth, inguinal LND --> absent knee jerk reflex
39
Obturator nerve root, function, injury
L3-4 Motor adduction of thigh, sensory to medial distal thigh Injury via transection, sling placement, or pelvic LND
40
Sacral nerve plexus nerve roots, and what nerves does it give rise to?
L4-5, S1-4 | Superior and inferior gluteal, posterior femoral cutaneous, sciatic, pudendal
41
Sciatic nerve root, function, path, gives rise to?
L4-S3 Motor and sensory components Exits pelvis through greater sciatic foramen inferior to the piriformis, courses along posterior thigh to popliteal fossa Terminates into tibial and common fibular (peroneal) nerves
42
Tibial nerve function
Motor and sensory to posterior compartment of the leg and foot
43
Common fibular (peroneal) nerve function and injury
Motor and sensory to anterior/lateral compartments of the leg and foot Injury due to insufficient padding of the knee during surgery --> foot drop
44
Pudendal nerve root, function, gives rise to?
S2-4 (keeps the penis off the floor!) Gives rise to inferior rectal, perineal, dorsal clitoral Motor and sensory to all perineal structures
45
Superior hypogastric plexus
Bifurcates to the left and right over the sacrum | Visceral afferent fibers relay pain sensation. These are transected for dysmenorrhea treatment. L3-4, S2-4
46
What plexus is at risk in Radical Hysterectomy or LAR?
Right and Left inferior hypogastric plexus (hypogastric nerves merge with pelvic splanchnic nerves) Pelvic = Parasympathetic, visceral afferent nerve fibers. Sacral splanchnic nerves = sympathetic

Fellows 2021! (10 decks)

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