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Repro and Sexual Health > Clinical Anatomy; pelvic mass, prolapse and incontinence > Flashcards

Clinical Anatomy; pelvic mass, prolapse and incontinence Flashcards

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1
Q

What is the ovary suspended on?

A

Suspended on a mesovarium from the posterior aspect of the broad ligament

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2
Q

Where does the ovary lie in terms of the pelvic side wall?

A

Ovary lies in the ovarian fossa

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3
Q

What is the relationship of the ovary to the ureter and internal iliac vessels?

A

Anterior to these

Obturator nerve is lateral to the ovary

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4
Q

What is the arterial supply to the uterus?

A

Supplied by the uterine artery which are branches of the internal iliac artery

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5
Q

What arteries do the uterine arteries anastomose with?

A

Ovarian arteries

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6
Q

What is the venous drainage of the uterus?

A

Internal iliac veins

Ovarian veins

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7
Q

At what aspect will the uterine pass the uterus?

A

Laterally
Pass above the ureter
Lateral to cervix
Lateral to vaginal fornices

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8
Q

At what vertebral level does the ovarian artery leave the aorta?

A

L2

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9
Q

In what ligament will the ovarian arteries run?

A

Broad ligament

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10
Q

What is the name for the part of the broad ligament that acts as mesentery?

A

Mesosalpinx

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11
Q

What is the relationship of the ovaries to the peritoneum?

A

Truly intraperitoneal

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12
Q

How can ovarian cancer spread?

A

Lymphatic drainage

Direct peritoneal spread

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13
Q

What are common sites of ovarian cancer mets?

A

GI tract
Bladder
Liver
Spleen

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14
Q

Via what lymphatics will ovarian cancer spread?

A

Pelvic and para-aortic nodes

Will then spread to the supraclavicular (virchow’s) node

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15
Q

Where are the lymph nodes of the pelvis found?

A 
Run alongside: 
Obturator
Internal iliac 
External iliac
Common iliacs 
Pre-sacral nodes in tissue immediately anterior to sacrum
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16
Q

Where will pelvic lymph converge?

A

Para-aortic nodes

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17
Q

Where will the para-aortic nodes drain into?

A

Lumbar trunks

Coalesce to form the cisterna chyli (contains thoracic duct)

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18
Q

Where can the inguinal nodes be found?

A

Outside fascia lata
Shaped like a T below and parallel to inguinal ligament
Along termination of long saphenous vein
Deep group; medial to femoral vein and in femoral canal

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19
Q

Where will superficial elements of the perineum drain to?

A

Inguinal nodes

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20
Q

Lymph drainage of rectum?

A

Sacral and internal iliac

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21
Q

Lymph drainage of anal canal?

A

Internal iliac

Lower portion to superficial inguinal

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22
Q

Lymph drainage of bladder?

A

Internal and external iliacs

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23
Q

Lymph drainage of the prostate and proximal urethra?

A

Internal iliac

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24
Q

Lymph drainage of the distal urethra, penile urethra, penis and clitoris?

A

Superficial inguinal

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25
Lymph drainage of the testis and ovaries?
Para-aortic
26
Lymph drainage of uterine tube, uterine fundus, upper uterine body?
Para-aortic
27
Lymph drainage of lower uterus, cervix and proximal vagina?
Internal and external iliacs | Sacral
28
Lymph drainage of distal vagina and vulva?
Superficial inguinal
29
What is the course of the ureter?
Lateral wall behind ovary Inferior to the uterine artery Posterior abdominal wall behind branches of superior mesenteric vessels (RHS) and inferior mesenteric vessels (LHS) Enters bladder wall obliquely at posterolateral corners of trigone
30
What are the stages to micturition?
Destruror muscle supplied by parasymp derived from pelvic splanchnics S2,3,4 Urethral smooth muscle supplied by sympathetic derived from T10-L2 but descend to bladder and urethra via hypogastric nerve Striated urethral sphincter and levator ani supplied by pudendal nerve
31
How is continence maintained during bladder filling and storage?
Muscle tone in the striated urethral sphincter and in pelvic floor (pudendal) Tone in urethral smooth muscle (symp)
32
What is a normal voiding volume?
400ml
33
Via what nerves is the sensation to micturate carried by?
Afferents that run in parallel with parasymp fibres
34
Why is there pressure on the bladder during pregnancy?
The anteverted and anteflexed uterus that expands puts pressure on the bladder
35
What is the vulva?
``` Urogenital female triangle: Mons pubis Labia majora and minora Vestibule Vaginal orifice Orifice of vestibular glands Clitoris ```
36
What is the anatomical location of the vagina?
Upward and backwards Through the pubovaginalis Anterior and posterior walls are opposed allowing a narrow opening Wall is composed of smooth muscle and mucous membrane is folded
37
Which vaginal fornix is directly related to the peritoneum of the recto-uterine pouch of douglas?
Posterior fornix
38
Within the female urogenital triangle, what surrounds the urethra and vagina?
Striated, external urethral sphincter | Supplied via pudendal nerve
39
What is the blood supply to the vagina and urethra?
Variable branches from uterine, vaginal and internal pudendal branches of internal iliac
40
What is the venous drainage of the vagina and urethra?
Vaginal plexus draining to internal iliac veins
41
What is the clitoris?
Commences at right and left crura (attached to ischopubic rami and covered by ischiocavernosus muscle) Surrounded by deep fascia and supported by suspensory ligament Glans is erectile tissue covered by highly sensitive thin skin
42
Where can the vaginal vestibular be found?
Between labia minora
43
What covers the bulbs of the vagina?
Bulbospongiosus muscle Bulbs are attaches to the superficial surface of the perineal membrane Meet at the anterior commissure at front of urethra
44
What is found under the posterior end of each vaginal bulb?
Greater vestibular gland
45
Describe the urethra in men?
Lubricated by mucous glands | Receives reproductive glands; prostatic and ejaculatory and spongy
46
Through which structure does the membranous urethra pass?
Urogenital diaphragm
47
Through which structure does the spongy urethra pass through?
Bulb of penis and then into corpus spongiosum
48
What surrounds the bulb of the penis?
Bulbospongiosus muscle
49
What is the arterial supply to the prostate, penis and urethra?
Inferior vesical Artery to bulb Dorsal artery of penis
50
What is the venous drainage of the prostate, penis and urethra?
Prostatic plexus | Internal iliac vein
51
What is the arterial supply to the female vulva and labia?
External pudendal arteries anteriorly (from femoral) | Posterior labial branches of internal pudendal posteriorly
52
What nerves must an epidural anaesthetic cover to achieve anaesthesia?
L1-S4
53
What are the supporting structures to the cervix and upper vagina?
Uterosacral, transverse cervical and pubocervical ligaments
54
What are the supporting structures to the middle vagina?
Pelvic fasci; pubocervical fascia and rectovaginal fascia
55
What are the supporting structures to the lower vagina?
Levator ani and perineal body
56
Which ligaments attach to the uterus?
``` Round ligament Ovarian ligament Uterosacral ligament Transverse cervical ligament Pubocervical ligament ```
57
Describe the uterosacral ligament
Strong structure that passes upwards and backwards from the posterior cervix towards lateral sacrum
58
Describe the transverse cervical ligament
Attaches to the cervix and upper vagina to the lateral walls of the pelvis
59
What are the different parts of the levator ani muscle?
Pubococcygeus Puborectalis Iliococcygeus Coccygeus
60
Describe the difference in location of the vestibular gland in men and women?
Men; deep perineal area | Female; superficial perineal area
61
What are factors that can lead to pelvic floor damage?
Increased intra-abdo pressure; obesity, chronic cough, occupational exercise, constipation, intra-abdo mass Pelvic floor muscle trauma and denervation; obstetric trauma, pelvic fracture, congenital Connective tissue; age, oestrogen deficiency, congenital or acquired, drug related (steroids)
62
Proximal and distal attachement of coccygeus muscle
P; ischial spine | D; inferior end of sacrum and coccyx
63
Proximal and distal attachment of puborectalis muscle
P; body of pubis | D; perineal body
64
Proximal and distal attachment of pubococcygeus muscle
P; pubic bone, tendinous arch of obturator fascia | D; vagina, perineal body, rectum, coccyx
65
Proximal and distal attachment of iliococcygeus muscle
P; ischial spine and tendinous arch | D; perineal body, coccyx
66
Which muscle of the levator ani creates a sling around the rectum?
Puborectalis; forms the ano-rectal angle
67
What is the main function of the pubococcygeus?
Compresses urethra, vagina and anus Controls urine flow Elevates recto-anal junction
68
What vessels can be damaged when inserting a trochar through the obturator membrane or through sacrospinous ligament?
Obturator artery, vein and nerves Insert trochar MEDIALLY Sacrospinoud; pudendal nerve, artery and vein
69
What muscle forms the lateral wall of the ischio-anal fossa?
Obturator internus muscle
70
What forms the roof of the ischio-anal fossa?
Levator ani and anal canal
71
What is the purpose of the ischio-anal fossa?
Allows rectal distention during defecation | Can be involved with abscesses
72
What is the clinical relevance of the ischioanal fossa?
Pudendal nerve passes in the lateral wall | Therefore for pudendal block and episiotomy, needle inserted through
73
What is the classical presentation of someone with an infection in the ischioanal fossa?
U shape redness around back of rectum
74
Where anatomically is the urogenital triangle?
Subpubic angle between ischiopubic rami

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