Anatomy Flashcards
(107 cards)
1
Q
What does the pelvic cavity include?
A
- ovaries
- uterine tubes
- uterus
- superior vagina
2
Q
What does the perineum include?
A
- inferior vagina
- perineal muscles
- Bartholin’s glands
- clitoris
- labia
3
Q
What is the true female reproductive organ?
A
ovaries
4
Q
What covers the superior aspect of the pelvic organs?
A
parietal peritoneum
5
Q
What is the most inferior part of the peritoneal cavity?
A
- recto-uterine pouch/pouch of Douglas
- lateral para-recta fossae which extend down slightly more inferiorly
6
Q
What is the broad ligament?
A
double layer of peritoneum extending between the uterus and the lateral walls and floor of pelvis
7
Q
What is the round ligament?
A
embryological remnant of the gubernaculum which attaches to the lateral uterus and attaches in the superficial labia majora
8
Q
What holds the uterus in position?
A
- strong ligaments eg uterosacral ligaments
- endopelvic fascia
- muscles of the pelvic floor
9
Q
What is the normal position of the uterus?
A
anteverted and anteflexed
variation is commonly retroflexed and retroverted
10
Q
Where do you take the sample in a cervical screening test?
A
squamocolumnar junction at the external cervical os
11
Q
What is the fornix?
A
- small pouch created by the cervix holding open the vagina
- anterior, posterior and 2x lateral
12
Q
What can you palpate digitally in the female system?
A
- uterus
- adnexae (uterine tubes and ovaries)
- ischial spines
13
Q
What makes up the diamond of the perineum?
A
- pubic symphysis, two ischial spines and the coccyx
- split into anal triangle inferiorly and the urogenital triangle superiorly
14
Q
What muscle forms the majority of the pelvic diaphragm?
A
levator ani
15
Q
What is the levator ani?
A
skeletal muscle under voluntary control which reflexively contracts when there is increased intra-abdominal pressure
16
Q
What is the nerve supply to the levator ani?
A
nerve to levator ani which is S3,4,5 but is likely to be a dual supply
17
Q
What is the perineal body?
A
- important for strength
- bundle of collagenous and elastic tissue
- just deep to the skin
18
Q
What is Bartholin’s gland?
A
greater vestibular gland (Cowper’s glands in the male) which lubricates the opening of the vagina which can be infected or can have a cyst
19
Q
Where is the female breast located anatomically?
A
- ribs 2-6
- mid-axillary line (tail of Spence)
- lateral border of the sternum
20
Q
What is under the breast tissue?
A
- retromammary space
- pec major/serratus anterior
21
Q
Where does the breast lymphatic system drain to?
A
- ipsilateral axillary nodes
- can drain to contralateral side
- inner quadrants can drain to parasternal
- lower quadrants can drain to abdomen
22
Q
What is the blood supply to the breast tissue?
A
- subclavian to the axillary
- internal thoracic
23
Q
What is the role of the pelvic floor?
A
- supports pelvic organs
- separates the pelvic cavity from the perineum
- maintains continence
24
Q
What is the pelvic floor made up of?
A
- pelvic diaphragm
- muscles of the perineal pouches
- perineal membrane
25
What is the pelvic diaphragm made up of?
levator ani and the coccygeus with anterior gap called the urogenital hiatus
26
What are the parts of the levator ani?
- medial=puborectalis
- middle=pubococcygeus
- lateral=iliococcygeus
27
What is the levator ani innervated by?
- pudendal nerve
| - nerve to levator ani
28
What state does the levator ani remain in at rest?
tonically contracted and then relies to allow urination and defecation
29
What provides additional support for the organs?
- endo-pelvic fascia
- pelvic ligaments including uterosacral, transverse cervical ligament (aka cardinal), lateral ligament of bladder and lateral rectal ligament
30
Where is the deep perineal pouch?
between the fascia covering the inferior aspect of the pelvic diaphragm and the perineal membrane
31
What is contained within the deep perineal pouch?
- urethra
- vagina (F)
- bulbourethral gland aka Cauper’s glands (M)
- neurovascular bundle for penis/clitoris
- extensions of the ischioanal fat pads
- muscles: external urethral sphincter, compressor urethrae and deep transverse perineal muscle (M)/smooth muscle (F)
32
What is the perineal membrane?
thin sheet of deep fascia which attaches to the pubic arch and closes over the neurogenic triangle with openings for the urethra and vagina
33
Where is the superficial perineal pouch?
superficial to the perineal membrane
34
What is in the superficial perineal pouch in the female?
- clitorus
- crura
- bulbs of vestibule
- pudendal nerve
- greater vestibular gland
- muscles: bulbospongiosus, ischiocavernosus and superficial transverse perineal muscle
35
What is in the superficial perineal pouch in the male?
- bulb of the penis
- crura
- pudendal nerve
- muscles: ischiocavernosus, bulbospongiosus and superficial transverse perineal
36
What are the layers of the perineum from deep to superficial?
- pelvic diaphragm (levator ani and coccygeus)
- deep perineal pouch
- perineal membrane
- superficial perineal pouch (erectile tissue then muscles superficially)
37
What is the perineal body?
ball of fibrous tissue with skeletal and smooth muscle that supports the pelvic floor
38
What does the pelvic floor do when there is increased intra-abdominal pressure?
active contraction eg in coughing, sneezing or vomiting
39
How is urinary continence maintained?
- external urethral sphincter
- compressor urethrae
- levator ani
40
How is faecal continence maintained?
puborectalis tonically and actively when rectum has filled
41
What are the mechanism of injury to the pelvic floor?
- pregnancy/childbirth causing pudendal nerve injury
- chronic constipation
- obesity
- heavy lifting
- chronic cough/sneeze
- menopause
42
What are the types of vaginal prolapse?
-cystocele (bladder)
-enterocele (SI)
-rectocele (rectum)
cause a lump in the vaginal wall
43
What are the types of uterine prolapse?
- 1st degree: cervix into vagina
- 2nd degree: cervix into opening of vagina
- 3rd degree: cervix outside of vagina
- 4th degree: entire uterus outside vagina
44
What is the surgical treatment for prolapse?
sacrospinous fixation can be done by attaching sutures to sacrospinous ligament to stop add support but risk to nerves
45
What is the mesh surgery for incontinence?
mesh through obturator foramen to make sling behind urethra
46
What bones meet in the acetabulum?
ilium
pubis
ischium
47
Where does the sacrospinous ligament attach and what does it form?
- sacrum and ischial spine
| - greater sciatic foramen
48
Where does the sacrotuberous ligament attach and what does it form?
- sacrum and ischial tuberosity
| - lesser sciatic foramen
49
Where is the obturator membrane?
covers the obturator foramen except for allowing nerves and vessels through
50
Where does the levator ani attach?
on both sides to the tendinous arch of levator ani which is a band of thickened fascia from the obturator muscle
51
Where does the coccygeus lie?
deep surface of the sacrospinous ligament
52
What is the lateral pelvic wall supplied by?
internal iliac artery
| exceptions are gonadal artery and the superior rectal artery
53
What is the arterial supply to the female pelvis?
- internal iliac is divided into:
- posterior (supplies parietal)=gluteal arteries (variation with the inferior gluteal so it might come from the anterior division)
- anterior (supplies viscera)= obturator artery (goes through obturator canal), superior vesical arteries (supply bladder), uterine artery (gives off vaginal artery), internal pudendal artery (this supplies the perineum by branches), middle rectal
54
What are the important anastomoses of the uterine artery?
- with the ovarian artery’s tubal and ovarian branches
| - with the vaginal artery
55
What is the 'water under the bridge'?
ureter going under the uterine artery
56
What branches does the internal pudendal artery give off in the female?
inferior rectal artery, perineal artery and terminates as the dorsal artery of the clitoris supplying the perineum
57
What is the difference to the male arterial system compared to the female?
- uterine artery is replaced with artery to vas deferens
| - vaginal artery is replaced with the inferior vesical artery
58
What do the artery to VD and prismatic branch come from?
inferior vesical arteries
59
What are the branches of the internal pudendal artery in the male?
- supplies the perineum in the male
- branches are the perineal artery, posterior scrotal, deep artery, dorsal artery of the penis but the anterior scrotal artery is a branch of the internal iliac
60
What is the medial umbilical ligament?
remnant of the umbilical artery and is present in both males and females
61
What is the venous drainage of the pelvis?
-form venous plexus and most drain into the internal iliac vein
-some drain via superior rectal to hepatic portal system
-some drain via lateral sacral veins into internal vertebral venous plexus
!!think mets!!
62
What is the obturator nerve formed of?
L2-4
63
What is the path of the pudendal nerve?
in through the sciatic foramen and back into perineum by lesser sciatic foramen
64
What are the nerves to the lateral pelvic wall?
- most formed from the sacral plexus
| - most important = sciatic nerve, pudendal (S2,3,4), nerve to levator ani and pelvic splanchnic nerves
65
What are the lymphatic nodes in the pelvis?
- deep inguinal
- superficial inguinal
- internal iliac
- external iliac
- common iliac
- lumbar
- inferior mesenteric
- sacral
- pararectal
66
What is the path of the superior pelvic viscera lymph?
external iliac nodes --> common iliac --> aortic --> thoracic duct
67
What is the path of the inferior pelvic viscera lymph?
deep perineum
- -> internal iliac
- -> common iliac --> aortic --> thoracic duct
68
Where does the superficial perineal lymph drain to?
superficial inguinal nodes
69
Where does the lymph from the ovaries and testes drain to?
lumbar nodes (as they originated on the posterior abdominal wall)
70
What bones fuse in the hip joint?
ilium
pubis
ischium
all join in the acetabulum
71
What is the pelvic inlet formed of?
- sacral promontory
- ilium
- superior pubic ramus
- pubic symphysis
72
What is the pelvic outlet formed of?
- pubic symphysis
- ischiopubic ramus
- ischial tuberosities
- sacrotuberous ligaments
- coccyx
73
What are the palpable bony features of the pelvis?
- iliac crests
- ASIS
- PSIS
- sacrum
- pubic tubercle
- pubic symphysis
- coccyx
- ischial tuberosity
74
What bony features of the pelvis can be palpated internally?
sacral promontory and the ischial spines (at 4 and 8 o’clock) on vaginal exam
75
What type of joints are the hip joint and the pubic symphysis?
hip joint = synovial
| pubic symphysis = secondary cartilaginous
76
What is the role of the sacrospinous and sacrotuberous ligaments?
- make sure the coccyx and sacrum aren’t pulled too superiorly in a weight transfer
- create the two sciatic foramen
77
What causes the ligaments of the pelvis to relax in pregnancy?
relaxin causes sacrospinous and sacrotuberous ligaments to relax
78
What are the features of a foetal skull?
- anterior fontanelle (closes 18m and 2y)
- posterior fontanelle (closes 6m and 1y)
- can be moulding which involves movement of one bone over another to allow foetal head to pass through pelvis
- vertex area between anterior and posterior fontanelle and the two parietal eminences
79
What is the important fact about size of baby's head?
occipitofrontal diameter is longer than the biparietal diameter so the baby has to go sideways through the pelvic inlet
80
What is 'station' in relation to childbirth?
- negative station is when the baby hasn’t reached the ischial spines in decent
- positive station is the baby is more inferior to spines
81
How does the baby exit the pelvic outlet?
- exits in the OA position so back of the head at the pubic symphysis
- head goes from flexion to extension during labour
- one last rotation to get shoulders out of the outlet
82
What is the type of innervation to the pelvis?
sympathetic, parasympathetic and visceral afferent so body cavity
83
What is the type of innervation to the perineum?
somatic motor and somatic sensory so body wall (pudendal nerve to S2-4) eg inferior vagina, perineal muscles, glands and skin
84
What is the path of nerves to superior pelvic organs/touching peritoneum?
- carried within visceral afferents
- run alongside sympathetic fibres for pain
- enter spinal cord between T11-L2
- pain is perceived as suprapubic
- eg uterine tubes, uterus and ovaries
85
What is the path of nerves to inferior pelvic organs/not touching peritoneum?
- within visceral afferents
- run alongside the parasympathetic fibres for pain
- enter spinal cord at S2-4 so this is where pain is perceived
- eg cervix and superior vagina
86
What is the innervation of structures that cross the levator ani?
- above the levator ani = with parasympathetics
- after levator ani = somatic as it is perineum with pudendal nerve
- !!same levels for both but different nerves
87
What are the nerve plexuses of the pelvis?
- sympathetics of the pelvis = superior hypogastric plexus
- parasympathetics of the pelvis = sacral outflow (S2-4) from spinal roots and mix with sympathetics in inferior hypogastric plexus
88
What are the features of spinal anaesthetic?
- anaesthetic is injected into L3-4 (the intercristal line goes nearly through L4)
- through dura and arachnoid mater and into the subarachnoid space
- sympathetic innervation is also blocked to everything below so there will be vasodilation of lower limb arterioles but beware of hypotension
89
When does the spinal cord become the caudate equina?
L2
90
When does the subarachnoid space end?
S2
91
What are the features of epidural anaesthetic?
needle goes through supraspinous, interspinous, ligamentum flavum and into epidural space
92
How is pudendal nerve block given?
use the ischial spine as a landmark PV to give anaesthetic vaginally with needle
93
What is an episiotomy?
- posterolateral incision done to stop perineum or pelvic floor muscles
- easier to repair an incision and you can direct a tear away from the external anal sphincter
94
What does a lower segment C section incision go through?
```
skin + fascia
anterior rectus sheath
rectus abdominis
fascia + peritoneum
retract bladder
uterine wall
amniotic sac
```
95
What does a laparotomy incision go through?
skin + fascia
linea alba
peritoneum
!!bloodless so increased chance of wound complications
96
Where is a laparoscopy incision?
subumbilical incision or lateral port
(careful to avoid inferior epigastric artery which is just medial to the deep inguinal ring and runs superomedially behind the rectus abdominis)
97
Where does the external oblique attach?
between the lower ribs and iliac crest, pubic tubercle and linea alba (hand in pockets)
98
Where does the internal oblique attach?
between lower ribs, thoracolumbar fascia, iliac crest and linea alba (hug yourself)
99
Where is the neurovascular plane in the abdomen?
between the transversus abdominis and internal oblique
100
Where does the transversus abdominis attach?
between lower ribs, thoracolumbar fascia, iliac crest and linea alba
101
What is the transversals fascia?
sheet of internal lining which is under the transversus abdominis
102
What divides up the rectus abdominis?
- tendinous intersections horizontally
| - linea alba vertically which goes from the xiphoid to the pubic symphysis
103
What does the arcuate line mark the change of?
- inferiorly, all of the aponeuroses are anterior to the rectus abdominis
- superiorly, the aponeuroses are both anterior and posterior to the rectus abdominis
104
Where is the arcuate line?
1/3rd of the way from umbilicus to pubic symphysis
105
What is the nerve supply to the anterolateral abdominal wall?
- enter from lateral
- move in neurovascular plane
- 7th-11th intercostal nerves become thoracoabdominal nerves
- T12 is subcostal
- L1 splits into iliohypogastric (S) and ilioinguinal (I)
106
What is the arterial supply to the anterior abdominal wall?
- superior epigastric arteries (continuation of internal thoracic)
- inferior epigastric arteries (branch of external iliac)
107
What is the arterial supply to the lateral abdominal wall?
intercostal and subcostal arteries
