anatomy revision

Question 1

what are paracolic gutters??

Answer 1

spaces between the colon and the abdominal wall

Question 2

pouches in women and men?? what is their clinical importance??

Answer 2

recto uterine - pouch of Douglas
vesico uterine

Question 3

name 9 regions of the abdomen

Answer 3

r and l
epigastric, r and l flank, suprapubic, r and l iliac fossa

Question 4

2 major arteries that supply blood to the brain??

Answer 4

coronary arteries
vertebral arteries

Question 5

where do majority of the arteries of pelvis and perineum arise from??

Answer 5

internal iliac artery

Question 6

where do the gonadal arteries arise from?

Answer 6

L2 - abdominal aorta
supplying the testicles and ovaries

Question 7

where do superior rectal artery arise from??

Answer 7

inferior mesenteric artery

Question 8

where does internal pudendal artery come from

Answer 8

internal iliac artery

Question 9

where does anterior scrotal artery come from

Answer 9

external iliac artery, from the common iliac artery

Question 10

clinical importance of anastomosis between uterine and ovary artery

Answer 10

ovarian artery coming from L2 (abdo aorta)
uterine artery coming from internal iliac artery
ovarian artery supplies part of uterus

Question 11

clinical importance of anastomosis between uterine and vaginal artery

Question 12

what structure Is v close to uterine artery and need to be careful when doing ligation??

Answer 12

ureter

need to be careful when doing hysterectomy

ureter wiggles when uterine artery does not

“water (ureter) under the bridge (uterine artery)”.

Question 13

where do left and right side of gonadal vein drain to??

Answer 13

left -> renal vein
right -> IVC

Question 14

where do the superior rectal vein mainly drain to??

Answer 14

internal iliac vein
some will drain into the hepatic portal system
or via lateral sacral veins into internal vertebral venous plexus

Question 15

which plexus does obturator
nerve come from??

Answer 15

lumbar plexus
L2-L4

other ones from sacral plexus - eg. pudendal, sciatic nerve

Question 16

S2,3,4??

Answer 16

PUDENDAL

pelvic splanchnic nerve - carries motor (also S2,3,4)

Question 17

Nerve to levator ani

Answer 17

L4

Question 18

lymphatics of pelvis - where do superior pelvic viscera go to??

There is a high amount of cross-over in the lymphatics of the pelvis - cancer can spread in any direction, pattern is not sufficiently predictable to anticipate spread

Answer 18

external iliac nodes -> common iliac, aortic

Question 19

where do inferior or deep pelvic viscera go to first

Answer 19

deep perineum -> internal iliac nodes -> common iliac

Question 20

where do superficial perineum go to first

Answer 20

superficial inguinal nodes

Question 21

GONADS LYMPHATIC DRAINAGE

Answer 21

para-aortic
or lumbar

Question 22

what makes up the ischium

Answer 22

ischial tuberosity - true hamstrings attach here, aka seat bone

Question 23

pelvic inlet / brim structures

pelvic outlet structures

Answer 23

prominent part of sacrum
ilium
superior public ramus
pubic symphysis

pubic symphysis
ischiopubic ramus
ischial tuberosities
sacrotuberous ligaments
coccyx

Question 24

why palpate pubic symphysis??

Answer 24

constant point to measure fundal height - and measure development of the foetus

Question 25

pubic symphysis relaxes

Question 26

are sacroiliac joints stable / unstable ?? what type of joint is it??

Answer 26

stable - synovial joint

Question 27

importance of the 2 ligaments of pelvis?? what 2 foramina do they form

Answer 27

sacrotuberous sacrospinous protects against sudden weight transfer eg. jumping greater + lesser sciatic foramina (when ligaments are not in place they are called greater + lesser sciatic notch)

Question 28

clinical relevance - trauma

Answer 28

fractures tend to break in multiple places eg like a pretzel

Question 29

clinical relevance - childbirth

Answer 29

- AP and transverse diameters of female pelvis are larger than male - subpubic angle and pubic arch is wider - pelvic cavity is more shallow in females

Question 30

moulding

Answer 30

the movement of 1 bone over another, to allow the foetal head to pass thru the pelvis during labour

Question 31

largest fontanelle??

Answer 31

soft spot anterior

Question 32

Above levator ani muscle = pelvis below = perineum

Answer 32

ABOVE - parasympathetic, visceral afferents BELOW - somatic sensory, pudendal nerve

Question 33

suprapubic pain is from what levels superior aspect of pelvic organs

Answer 33

T11-L2

Question 34

inferior aspect of pelvic organs

Answer 34

S2,3,4

Question 35

at what level is anaesthetic injected ??

Answer 35

L3-L4 region

Question 36

epidural anaesthetic pathway

Question 37

spinal anaesthetic pathway - what structures does it pass thru?

Answer 37

faster-acting anaesthetic compared to epidural skin supraspinous ligament interspinous ligament ligamentum flavum  

Question 38

what happens if there is a blockade of sympathetic tone to all arterioles in lower limb??

Answer 38

vasodilation may also cause hypotension

Question 39

what structure is used as a landmark for pudendal nerve block??

Answer 39

ischial spine for things like forceps delivery, painful vaginal delivery, episiotomy incision (posterior fourchette, where the labia minora meet posteriorly, between vagina and perineum)

Question 40

1-4th degree tear

Answer 40

1st - skin only 2nd - 3rd - anal sphincter 4th - thru anal sphincter and bowel

Question 41

LSCS what structures do you incise through??

Answer 41

Lower segment C-section, part of uterus where it is thinner, incise thru skin fascia anterior rectus sheath rectus abdominis but NOT rectal muscles fascia and peritoneum retract bladder uterine wall amniotic sac

Question 42

laparotomy vs laparoscopy - what structures do u cut thru

Answer 42

midline incision - which is bloodless but increases risk of wound complications skin and fascia linea alba perineum laparoscopy - sub umbilical incision

Question 43

abdominal vs vaginal hysterectomy

Answer 43

removal of uterus either thru abdominal wall or vagina

Question 44

nerve supply to abdo wall

Answer 44

7th-11th nerves turn from intercostal nerves to thoracoabdominal nerves T12 = subcostal and iliohypogastric L1 = ilioinguinal

Question 45

blood supply to abdo wall

Answer 45

intercostal and subcostal arteries superior epigastric artery be careful of the inferior epigastric artery

Question 46

relationship between arcuate line and rectus sheath

Answer 46

above = anterior and posterior rectus sheath below = anterior rectus sheath

Question 47

how to find the deep inguinal ring??

Answer 47

halfway between ASIS and pubic tubercle

Question 48

structures found in pelvic inlet vs outlet

Answer 48

inlet = ilium, pubic symphysis outlet =

Question 49

Which nerves and vessels may be damaged as a result of pelvic trauma?

Answer 49

brachial nerve palsy - erb's and klumpke's facial nerve damage

Question 50

Describe the preferred position of the fetal head as it descends through each region of the pelvis during labour, through to delivery. Understand and describe why these rotations have to occur.

Answer 50

transverse OA

Question 51

3 muscles that make up the pelvic floor?

Answer 51

pelvic diaphragm deep perineal pouch perineal membrane

Question 52

deepest layer of the pelvic floor?? what 2 muscle groups does it contain??

Answer 52

pelvic diaphragm levator ani and coccygeus

Question 53

3 muscle groups of levator ani

Answer 53

puborectalis pubococcygeus iliococcygeus

Question 54

endo-pelvic fascia pelvic ligaments - extra support

Answer 54

utero-sacral transverse cervical tendinous arch of pevlic fascia tendinous arch of levator ani

Question 55

what structures are inside the deep perineal pouch to get rid of urine and fixate perineal body

Answer 55

dorsal vein of clitoris / penis external urethral sphincter compressor urethrae -bulbourethral aka cowper's gland in males -deep transverse perineal muscle

Question 56

what is the perineal membrane

Answer 56

covers the urogential triangle

Question 57

superficial perineal pouch - contains erectile tissue what makes up the clitoris and crura

Answer 57

corpus cavernosum crura - like crucifix, long thing at each side bulb

Question 58

another name for greater vestibular glands

Answer 58

bartholin's gland

Question 59

in males, what makes up the bulb and crura

Answer 59

corpus spongiosum - bulb corpus cavernous - crura

Question 60

functions of pelvic floor

Answer 60

support to pelvic organs normally tonically contracted actively contracts during sneezing, coughing helps maintain continence -urinary (external anal sphincter) -faecal (puborectalis contraction, smaller angle)

Question 61

injury to the pelvic floor

Answer 61

*pregnancy *childbirth obestiy chronic constipation

Question 62

1st-4th degree of prolapse

Answer 62

1st - cervix has dropped down into the superior part of the vagina 2nd - more than halfway down 3rd - cervix is protruding from the vaginal orifice 4th - completely outside vagina