Anatomy Flashcards
(136 cards)
1
Q
What is the only true female reproductive organ?
A
Ovaries
2
Q
What makes up the pelvic cavity?
A
Ovaries, uterine tube, uterus, superior part of the vagina
3
Q
Name the contents of the perineum
A
Inferior part of the vagina, perineal muscles, Bartholin’s glands, clitoris, labia
4
Q
What is the peritoneum?
A
Thin, transparent serous membrane that lines the abdominal cavity and wraps around organs - covers superior aspect of organs
5
Q
Name the two peritoneal pouches in females
A
Vesico-uterine
Recto-uterine (Pouch of Douglas)
6
Q
What is the clinical significance of the Pouch of Douglas?
A
Most inferior part of the peritoneal cavity can collect excess fluid
7
Q
How is the pouch of Douglas drained?
A
Though the posterior fornix of the vagina
8
Q
Describe the broad ligament
A
Double layer of peritoneum that extends between the uterus and the lateral walls of the pelvic floor - helps to maintain the uterus in the midline position
9
Q
Describe the round ligament
A
Embryological remnant attaches to the lateral aspect of the uterus, passes through the deep inguinal ring to attach to the superficial tissue of the perineum
10
Q
Name the three layers of the uterus
A
- perimetrium
- myometrium
- endometrium
11
Q
Where does implantation occur?
A
Body of the uterus
12
Q
What is the common position of the uterus?
A
Anteverted and anteflexed
13
Q
Describe the term anteverted and anteflexed
A
Cervix is tipped anteriorly relative to axis of the vagina
Uterus tipped anteriorly relative to axis of cervix
14
Q
Name the common variation of uterus position
A
Retroverted and retroflexed
15
Q
Describe the different parts of the uterine tubes
A
Isthmus, ampulla, infundibulum with fimbrae which open into the peritoneal cavity
16
Q
What is the disadvantage of the uterine tubes opening into the peritoneal cavity?
A
Infection can enter here
17
Q
How many fornix can be found in the vagina?
A
4
Anterior
Posterior
2 lateral
18
Q
What two triangles can be separated by an imaginary line between the two ischial spines?
A
Urogenital
Anal
19
Q
What is the function of the pelvic floor?
A
Provides support to pelvic organs and maintains continence
20
Q
Name the two muscles of the pelvic diaphragm
A
- levator ani
- coccygeus
21
Q
What are the three parts of the levator ani?
A
- puborectalis (pubic bone and anus)
- pubococcygeus (pubic bone and coccyx)
- iliococcygeus (ilium and coccyx)
22
Q
Describe the perineal body
A
Collection of collagenous/elastic tissue into which the perineal muscles attach
23
Q
Describe the action of levator ani
A
All tonically contracted most of the time, must relax to allow urination and defection
24
Q
What nerve supplies the levator ani?
A
Pudendal nerve and nerve to levator ani
25
Which nerve innervates coccygeus?
Branches of S4 and S5
26
What two structures give additional support to the pelvic floor?
Endo-pelvic fascia
| Pelvic ligaments
27
Name four pelvic ligaments
- uterosacral
- transverse cervical
- lateral ligament of bladder
- lateral rectal ligaments
28
Where can the deep perineal pouch be found?
Shallow compartment lies between the fascia covering the inferior pelvic diaphragm and the perineal membrane
29
Describe the contents of the deep perineal pouch
Part of urethra and vagina, bulbourethral gland in males, neuromuscular bundle (clitoris/penis), anterior extensions of ischioanal fat pads, muscles
30
Which muscles are found in the deep perineal pouch?
External urethral sphincter
Compressor urethrae
Deep transverse perineal muscle (males)
Band of smooth muscle (females)
31
Where is the perineal membrane?
Superficial to the deep perineal pouch
32
What is the perineal membrane made of and where does it attach?
Thin sheet of tough deep fascia.
| Attaches laterally to the pubic arch and closes over the urogenital triangle
33
Where is the superficial perineal pouch?
Superficial to the perineal membrane
34
What does the superficial perineal pouch contain in women?
Clitoris and crura - covered by ischiocavernosus
Bulbs of vestibule - covered by bulbospongiosus
Bartholins glands, transverse perineal muscle branches of vessels and nerves
35
What does the superficial perineal pouch contain in men?
Bulb - corpus spongiosum (bulbospongiosus)
Crura - corpus cavernosum (ischiocavernosus)
Proximal spongy urethra, superficial transverse perineal muscle, pudendal nerves/vessels
36
Where does the breast extend to/from?
Ribs 2-6
37
What does the breast tissue sit on?
Deep fascia covering the pecs major and serratus anterior
38
Name the space found between the fascia and breast
Retromammary Space
39
How is the breast tissue attached to the skin?
Suspensory ligaments
40
Where does most lymph from the breast drain?
Ipsilateral axillary then supraclavicular nodes
41
Where can lymph from the inner quadrants of the breast drain?
Parasternal nodes
42
Where can lymph from the lower quadrants drain?
Abdominal nodes
43
What is the arterial supply to the breast?
- anterior intercostal branches of the internal thoracic artery from the subclavian artery
- branches of the axillary
- posterior intercostal arteries
44
What is the venous drainage of the breast?
Axillary vein and internal thoracic vein
45
What is the tissue extending to the mid-axillary line called?
Tail of Spence
46
What bones make up the lateral pelvic wall?
Pubis, ischium and ilium
47
Name three ligaments found in the lateral pelvic wall
Sacrospinous
Sacrotuberous
Obturator Membrane
48
What does the obturator membrane fill?
The obturator foramen - NVB passes through the canal
49
What do the sacrospinous and sacrotuberous ligaments form?
Greater and lesser sciatic foramen
50
Name four muscles that are in the lateral pelvic wall
Levator ani
Obturator Internus
Piriformis
Coccygeus
51
Where does the levator ani attach?
Tendinous arch - band of thickened fascia from the obturator interns muscle
52
Where does the obturator internus tendon pass?
Between the superior and inferior gemellus
53
Describe the route of the piriformis muscle
Passes through the greater sciatic foramen and attaches to the greater trochanter of the femur
54
Why is the piriformis an important landmark?
Where the sciatic nerve emerges and the gluteal nerve divides
55
What is the major blood supply to the pelvis?
Internal iliac artery
56
What are the two exceptions to the internal iliac blood supply?
Gonadal artery - arises at L2 from abdominal aorta
| Superior rectal artery - continuation of the inferior mesenteric
57
Describe the division of the internal iliac artery
Anterior - visceral
| Posterior - parietal
58
What remnant is found relating to foetus blood supply?
Medial umbilical ligament from the umbilical artery which connected the internal iliac to the placenta
59
What branches arise from the posterior division of the internal iliac?
Gluteal arteries - inferior may come from the anterior division
60
What branches arise from the anterior division of the internal iliac?
Obturator artery
Superior vesicle arteries - supplies the bladder
Uterine artery - gives off vaginal artery
Internal pudendal
61
Which artery does the middle rectal artery arise from?
Internal pudendal
62
What arteries arise from the vaginal artery?
Inferior vesicle
63
Describe the two anastomoses in the pelvic blood supply
Uterine and ovarian
| Uterine and vaginal
64
What structure lies close to the uterine artery and can be damaged during a hysterectomy?
Ureter - water under the bridge
65
Describe the differences between the right and left ureter
Right - lies more laterally and crosses external iliac
| Left - lies more medially and crosses the common iliac
66
What two arteries supply the perineum ?
Internal pudendal
| External iliac
67
What are the branches of the internal pudendal nerve in females?
Inferior rectal
Middle rectal
Dorsal artery of clitoris (where it terminates)
Perineal artery
68
What is the branch of the external iliac artery in females?
Labial arteries
69
In the male where do the inferior vesicle arteries arise?
Internal iliac artery
70
What two branches arise from the inferior vesicle arteries?
Prostatic branch
| Artery to vas deferens
71
What are the branches of the internal pudendal nerve in males?
Perineal
Posterior scrotal
Deep artery
Dorsal artery of penis (termination)
72
What branch of the external iliac artery supplies the perineum in males?
Anterior scrotal
73
Name the three common venous drainage systems of the pelvis
Internal iliac vein to IVC
Superior rectal and into the portal-hepatic system
Lateral sacral and to the internal vertebral venous plexus
74
Describe the route of the obturator nerve
Formed from lumbar plexus (L2,3,4) and passes through extraperitoneal fatty tissue to the obturator canal
75
Describe the route of the pudendal nerve
S2,3,4 exits via the greater sciatic foramen posterior to the sacrospinous ligament and comes back into the perineum via the lesser sciatic foramen
76
What spinal levels does the nerve to the levator ani arise?
S3,S4
77
What are the pelvic sphlanic nerves?
Exit via the anterior rami of S2,3,4 carry parasypathetic innervation
78
Name the lymph nodes that the pelvis drains to
```
Lumbar/aortic
Inferior mesenteric
Common iliac
External iliac
Internal iliac
Superficial inguinal
Deep inguinal
Sacral
Pararectal
```
79
Generally where does the superior pelvic viscera drain lymphatically?
External iliac nodes
80
Generally where does the inferior pelvic viscera drain?
Internal iliac nodes
81
Where does lymph from the superficial perineum drain?
Superficial inguinal nodes
82
Where does lymph from the ovaries and testes drain?
Lumbar lymph nodes
83
Describe transperitoneal spread
Usually peritoneal layer can act as a barrier to infection but eventually disease can penetrate and the disease can travel in fluid or on the layer itself
84
State the functions of the bony pelvis
```
Supports upper body
Transference of weight
Attachment of muscles
Attachment of external genitalia
Protection of pelvic organs
Passage of childbirth
```
85
What makes up the bony pelvis?
Hip bones (ischium, ilium, pubis)
Sacrum
Coccyx
86
Name the landmarks of the ilium
Iliac crest
ASIS
PSIS
Iliac fossa
87
Name the landmarks of the ischium
Ischiopubic rams
Ischial spine
Ischial tuberosity
88
Name the landmarks of the pubis
Ischiopubic ramus
Superior pubic ramus
Pubic tubercle
Pubic arch
89
How do you palpate the ischial spines?
4 and 8 o'clock internally
90
State the key differences between the male and female pelvis
AP and transverse diameter bigger in females
Subpubic angle wider in females
Pelvic cavity is more shallow in females
Greater sciatic notch is wider in females
Sacral promontory less pronounced in females
Female bones are thinner and males more robust
91
What makes up the pelvic inlet?
Sacral promontory
Ilium
Superior pubic ramus
Pubic symphysis
92
What makes up the pelvic outlet?
```
Pubic symphysis
Ischiopubic ramus
Ishchial tuberosities
Sacrotuberous ligaments
Coccyx
```
93
What are the key joints in the bony pelvis?
```
Sacroiliac (synovial and syndymoses)
Hip joint (synovial)
Pubic symphysis (cartilaginous)
```
94
Describe the pelvic movement during pregnancy
SI joint rotates anteriorly and inferiorly causing the sacrum and coccyx to rise but the ligaments prevent this from going too far
95
What happens to the ligaments in late pregnancy?
Relax due to a hormone - relaxin
96
What tends to happen to ring bones in trauma?
They fracture in more than one place or combined with joint dislocation
97
Name the two fontanelles in foetus
Anterior - closes 18 months to 2 years
| Posterior - closes 6 months to 1 year
98
What happens to the foetal skull during childbirth?
Moulding - movement of one bone over another to allow the head to pass through the pelvis
99
What is the foetal vertex?
Diamond - pariteal eminences and fontanelles
100
Define station
Distance of foetal head from the ischial spines
- negative if above
- positive if below
101
Describe the rotation of the baby during childbirth
1.
2. Head moves into
3. Shoulders align with AP and baby faces thigh
102
What type of nerves supply the pelvis?
Body cavity
- sympathetic
- parasympathetic
- visceral afferent
103
What type of nerves supply the perineum?
Body wall
- somatic motor
- somatic sensory
104
Describe the innervation of superior aspect of pelvic organs/touching the peritoneum
Visceral afferents, run alongside the sympathetic fibres and enter the spinal cord between T11 and L2
105
Describe the innervation of inferior pelvic organs
Visceral afferents run alongside parasympathetic and enter the spinal cord at S2,3,4
106
What happens to structures that cross from pelvis to perineum?
Above levator ani - visceral afferents - S2,3,4
| Below levator ani - somatic sensory - S2,3,4 (pudendal nerve)
107
At what level does the spinal cord become the caudal equina?
L2
108
When does the subarachnoid space end?
S2
109
How can L4 spinous process be identified?
Intercrestal Line
110
What does the needle to the epidural space pass?
Supraspinous ligament
Interspinous ligament
Ligamentum flavus
Epidural space - fat and veins
111
What does the needle to the spinal space pass?
```
Supraspinous ligament
Interspinous ligament
Ligamentum flavus
Epidural Space
Dura mater
Arachnoid mater
Subarachnoid space - filled with CSF
```
112
What do the sympathetic nerves supply all of?
Arterioles
113
What is the effect of blockage of the sympathetic nerves?
Vasodilation - reduced sweating, red, flushed, hypotension
114
How is the pudendal nerve located?
Ischial spine, travels lateral and behind the sacrospinous ligament
115
What is the purpose of episiotomy?
Posterolateral incision to prevent rectal damage and makes the tear towards the fat filled ischioanal fossa which is easier to repair
116
Name four abdominal wall muscles
External oblique
Internal oblique
Transversus abdominus
Rectus abdominus
117
Where does the external oblique attach and what direction does it run?
```
Lower ribs (5-12), iliac crest, pubic tubercle, linea alba
Inferomedial direction
```
118
Where does the internal oblique attach and what direction does it run?
Attaches to lower ribs 10-12, thoracolumbar fascia, iliac crest, linea alba
Posteromedially
119
Where does the transverses attach?
Lower ribs 7-12, thoracolumbar fascia, iliac crest, linea alba
120
What fascia layers lie above and below transversus abdominus?
Neuromuscular plane - between muscle and IO
| Transversalis fascia - internal lining deep to muscle
121
Describe the rectus abdominus
Made up of 3/4 smaller muscles with tendinous intersection
| Attaches to xiphoi, costal cartilage and pubic bones
122
Describe the linea alba
Interweaving of aponeuroses, runs from xiphoïde process to pubic symphysis with lots of small vessels and nerves
123
What is the rectus sheath?
Deep to the superficial fascia, combined aponeuroses of anterolateral abdominal muscles
124
What nerves supply the abdominal wall muscles and where does this come from?
All enter from lateral direction.
7th-11th intercostal nerves to thoracoabdominal nerves
T12 - subcostal
L1 - iliohypogastric and ilioinguinal
125
What blood vessels supply the anterior wall?
Superior epigastric arteries from internal thoracic - in the rectus sheath
Inferior epigastric arteries from external iliac
126
What blood vessels supply the lateral wall?
Intercostal and subcostal arteries - continuation of posterior intercostal arteries
127
What is usually done during a LSCS?
Rectus muscles are separated laterally towards nerve supply
128
What layers will be passed during LSCS?
Fascia - sheath - rectus abdominus - peritoneum - retract bladder - uterine wall - amniotic sac
129
What layers are stitched following LSCS?
Uterine wall, visceral peritoneum, rectus sheath, skin
130
What layers are passed in a laparotomy?
Skin, fascia, linea alba, peritoneum
131
Which layers requiring stitching post laparotomy?
Peritoneum, linea alba, fascia and skin
132
What is the benefit/risk of a midline incision?
Benefit - relatively bloodless
| Risk - wound complications
133
Describe the route of the epigastric artery
Emerges medial to deep inguinal ring and passes superomedially posterior to rectus abdominus
134
Where should lateral ports be placed?
Lateral to inferior epigastric artery
135
Where is the deep inguinal ring?
Half way between ASIS and pubic tubercle
136
Describe a vaginal hysterectomy
Local anaethetic around the cervix reflect bladder superiorly. Ligate arteries and ligaments and tubes. Remove uterus and cervix via vagina
Ligaments may be sutured to the vagina to prevent prolapse
