ERS anat Flashcards
List the organs located in the true pelvic cavity? What supports the organs?
Urinary bladder Rectum Anal canal Female and male reproductive organs Nerves, vessels and lymphatics
Pelvic Diaphragm (PD)
List the main general nerve, blood supply of true pelvic cavity?
Nerve = hypogastric plexus Blood = internal iliac a.
Peritoneal position, shape and mucosal folds of the rectum?
Retroperitoneal
Ampulla = widest and most distendible
3 transverse folds = Valve of Houston: 1 on right, 2 on left
Muscle the maintains continence in the rectum?
Rectal sling = Puborectalis muscle
Structures anterior and posterior to rectum?
Anterior = Rectovesical pouch (male)/ Rectouterine pouch (female)
Posterior = Sacrum, sacral nerves, LN
Blood supply + veins of rectum (3)
Superior rectal artery (Inf. mesenteric a.)»_space; Inferior mesenteric vein
Middle rectal artery (internal iliac a.)»_space; Internal iliac v.
Inferior rectal artery (Internal pudendal a.)»_space; Internal iliac vein
Lymph and nerve supply of rectum?
Lymph: Preaortic, Pararectal, Inferior mesenteric LN
Nerve: Inferior hypogastric plexus
Examination techniques of rectum?
Digital rectal exam
Proctosigmoidoscopy
Colonoscopy
Spread of rectal cancer routes (3)
Posterior = sacral plexus (pain!) Anterior = direct invasion, bladder, prostate, uterus/ vagina Lymph = to liver
Anal canal: Compare mucosa lining, blood supply and vein of Upper and Lower anal canal?
Upper:
- Columnar epi.
- Superior rectal a (inf. mesenteric a.)
- Superior rectal vein (inf. mesenteric v.)
Lower:
- Stratified squamous epi.
- Inferior rectal a.(pudendal a.)
- Inferior rectal v.(internal iliac v)
Anal canal: Upper and Lower parts’ Nerve and LN?
Upper anal:
- Hypogastric plexus (ANS)
- Pararectal nodes
Lower half:
- Inf. rectal nerve (pudendal nerve, somatic)
- Superficial inguinal nodes
Internal and External anal sphincter nerve supply + MUSCLE name ?
Internal = SPHINCTER ANI = circular smooth muscle
= Inf. hypogastric plexus
External = SPHINCTER ANI EXTERNUS
= Perineal branch of S4 nerve + Inferior rectal nerve (pudendal n.)
Clinical outcome of torn Pelvic diaphragm in female? Outcome of torn Urogenital Diaphragm
PD = Prolapse of pelvic visecrea through perineum
UD = urinary incontinence
3 parts of male urethra?
Prostatic urethra: most dilatable, ejaculatory duct
Membranous urethra: within Urogential diaphragm, sphincter = UD
Spongy urethra: longest, ends at Fossa Navicularis
Part of male urethra most prone to damage? Which part has bulbourethral gland?
Membranous urethra: most prone to damage: fixed and narrow
Urogenial diaphragm contains bulbourethal/ greater vestibular gland
Location of prostate and tissue type? Lobes?
Below bladder, Above perineal membrane
Fibromuscular connective tissue
5 lobes: 2 lateral, 1 posterior, 1 median, 1 anterior
Lobes of prostate prone to malignancy?
Posterior lobe = Malignancy, prostatic carcinoma (BATSON PLEXUS TO SPINE)
Median lobe = BPH
Secretion of Prostate? Lobes in relation of ejaculatory duct?
Citric acid
Acid phosphatase
Ejac. duct = between psoteiror and median lobes
Blood supply and vein + Lymph + nerve of prostate?
Blood supply: Inferior vesical a. + Middle rectal a.
Vein: Prostatic plexus > Interional iliac vein
Lymph: Internal iliac LN
Nerve: Inferior hypogastic plexus
Area below Pelvic diaphragm? Artery and nerve supply?
Perineum
= House external genitalia
Divided into superficial and deep perineal space/ pouches
Internal pudenal artery
Pudendal nerve
List the muscles of the pelvic diaphragm.
From medial to lateral:
1) Levator ani muscles:
- Puborectalis (rectal sling)
- Pubococcygeus
- Iliococygeus
2) Coccygeus muscle
Clinical significance of Coccygeus muscle? Nerve supply and action?
Detroyed perineal body/ PD = prolapse of bladder, uterus/ vagina, rectum
Nerve = Sacral nerves (4,5) + pudendal nerve
Action = Support pelvic viscera + sphincter for anarectal junction and vagina
4 parts of uterus and natural position?*
Fundus, Cornu, Body, Cervix
Anteverted + Anteflexed
Primary and secondary support for uterus?
Primary = PD + UD
Secondary:
1) Broad ligament = peritoneum fold, gives rise to mesosalphinx + mesovarium for fallopian tube + ovaries
2) Pelvic Fasciae Condensation: Connective tissue from pelvic wall and floor: - Uterosacral lig. - Pubocrvical lig. - Transverse cervical lig.
Blood supply + vein + LN + nerve supply of uterus.
Blood supply = Uterine a. (internal iliac a.)
Vein = Uterine venous plexus > internal iliac v.
LN: External and internal iliac + Sacral LN
Nerve = Inf. hypogastric plexus
Position of uterine artery and Ureter? Clinical significance?
Uterine artery = ABOVE ureter
Hysterectomy = accidental ligation of ureter
4 parts of fallopian tube + support?
Isthmus, ampulla, infundibulum, fimbriae
Broad ligament enclosing the tube
Blood supply for Fallopian tube?
Ovarian and uterine arteries
Clinical significance of Fallopian tube?
Common site for ectopic pregnancy
Pelvic inflammatory disease
3 supports for Ovaries + LN + nerve supply?
Mesovarium from broad ligament Suspensory ligament (w/ vessels) Proper Ligament of Ovary (from uterine body)
LN = Paraaortic LN
Nerve = Aortic plexus
Blood supply of ovaries.
Artery = Ovarian + Uterine arteries
Vein:
- Left ovary = Left renal
- Right ovary = IVC
Explain the referred pain from ovary disease.
Ovary close to Obturator nerve
Referred pain to medial thigh and knee
Name of 2 spaces in vagina + list supports.
2 spaces = Anterior + posterior Fornix
Upper = PD + Pelvic viscera Middle = UD Lower = Perineal body
Blood supply + vein for vagina.
Upper = Uterine + Internal iliac Middle = Middle rectal Lower = Internal pudendal arteries
Vaginal venous plexus > Internal iliac vein
LN and nerve for Vagina.
LN:
- Upper + middle = Internal and External iliac LN
- Lower = Internal iliac LN + Superficial inguinal LN
Nerve:
Upper = Uterovaginal plexus (Inf. Hypogastric plexus)
Lower = Pudendal Nerve
Nerve supply of vagina.
Upper = uterovaginal plexus Lower = pudendal nerve
Explain the spread of bacteria causing PID from the vagina.
Posterior fornix = close to uterine pouch
If superior wall is punctures during D&C procedure, bacteria spread through to pelvic cavity and peritoneum
What divides the perineum into 2 triangles?
Line across Ischial tuberosity
Divide into Anal and Urogenital triangles
Content of anal triangle?
Anal canal
Ischiorectal fossa
Anoccocygeal body/ ligament
Location and clinical significance of ischiorectal fossa?
Lateral to anal canal
Adipose tissue with poor B/V supply = prone to infection + abscess
Content of ischiorectal fossa?
Internal pudendal vessels
Pudendal nerve
External anal sphincter
External anal venous plexus
Male urogenital triangle divisions?
Deep perineal pouch = Urogenital diaphragm (muscles)
Superficial perineal pouch = below UD = external genitalia
Content of Deep perineal pouch in male urogenital triangle? Boundaries?
Superficial and inferior fascia of UD
Content: MBDISD Membranous urethra Bulbourethral glands Internal pudendal vessels Dorsal nerves of penis Deep transverse perineal muscle Sphincter urethrae
2 layers of the superficial perineal pouch of male urogenital triangle?
Fatty layer: Dartos muscle (scrotum) from Campers fascia (abdomen)
Membranous layer: Colles’ fascia (scrotum) from Scarpa’s fascia (abdomen)
Content of superficial perineal pouch of male urogenital triangle?
Bulbospongiosus + Ischiocavernosus muscles
Superficial transverse perineal muscle
Deep perineal branch of pudendal nerve + Internal pudendal vessels
2 parts of the penis?
- Root = Crura and bulb
- Body
Crura (lateral)»_space; 2 corpus cavernosum
Bulb (medial, attached to UD)»_space; corpus spongiosum + glan penis
Blood supply of penis?
Internal Pudendal artery: branches:
- Deep artery = corpus cavernosum
- Dorsal artery = corpus cavernosum, skin
- Artery to bulb of penis = erectile tissue + bulbourethral gland)
- Urethral artery = spongy urethra
(+Inferior rectal a. + Perineal a.)
Vein drain of penis
Internal Pudendal vein > internal iliac vein
Deep dorsal vein»_space; prostatic plexus
Superficial dorsal vein»_space; Femoral vein
Lymphatics of penis
Scrotum + superficial penis»_space; superficial inguinal nodes
Deep penis»_space; internal iliac nodes + deep inguinal LN
Nerve supply of penis?
Pudendal nerve S2-S4
Branches:
Inferior rectal n. + Perineal n. + Dorsal nerve of penis
List all parts of the female external genitalia
Libia majora + Minora
Mons pubis
Vesticular fossa
Clitoris ( crura = 2x corpus cavernosa + body = glans)
Vaginal orifice + hymen
Content of the deep perineal pouch of female urogenital triangle?
Same as Male DPP:
Urethra, Sphincter urethrae, Internal pudendal vessels, Deep transverse perineal muscle
Different:
Paraurethral glands + greater vestibular glands
Dorsal nerve of clitoris
Content of superficial perineal pouch in female urogenital triangle?
Bulbospongiosus + Ischiocavernosus
Superficial transverse perineal muscle
Clitoris
Greater vestibular gland
Bulb of vestible
Perineal nerve + internal pudenal vessels
Muscles attached to perineal body in female?
External anal sphincter + superficial transverse perineal muscle + bulbospongiosum
Blood supply of female superficial perineal pouch?
Internal Pudendal artery
Branches: Posterior labial Deep artery of clitoris Dorsal artery of clitoris Perinal a. Urethral a. Artery of Bulb of vestibule
Vein drain of female SPP? LN drain?
Internal pudendal > internal iliac vein
Superficial inguinal LN
Nerve supply of female SPP?
Pudendal nerve
Branches:
Inferior rectal, perineal, Dorsal nerve of clitoris
4 causes of hemorrhoids?
Chronic constipation
Portal hypertension
Rectal tumour
Pregnancy
Rupture of membranous urethra clinical sequaelae?
Urine leaks into SPP
Penile superficial fascia is continuous with abdomin fascia»_space;> urine to anterior abdominal wall
Tract ducts of breast?
15-20 lobes separated by fibrous septa/ suspensory ligament > lactiferous duct > ampulla > nipple
Blood supply for breasts?
Axillary artery \+ internal thoracic artery \+ Intercostal artery \+ Lateral thoracic a. \+ thoracoacromial a.
LN drainage of breast?
Medial quadrant = Internal mammary chain/ Internal thoracic LN
Lateral quadrant = Anterior Axillary LN > Central LN > Apical LN > Subclavian trunk > thoracic duct/ Right lymphatic duct
