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MRCS Part A (KF edition) > Pelvic anatomy > Flashcards

Pelvic anatomy Flashcards

(76 cards)

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1
Q

What structures lie posterior to the kidneys?

A
  • Quadratus lumborum
  • Diaphragm (arcuate ligament)
  • Psoas major
  • Transversus abdominis
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2
Q

What is the arrangement of structure in the pedicle of the kidney?

A

VAP

  • Renal vein (Anterior)
  • Renal artery (Middle)
    -Pelvis of ureter (posterior
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3
Q

At which vertebral levels do the renal arteries arise?

A

Right renal artery - L2

Left renal artery - L1

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4
Q

What are the anatomical relations of the right adrenal gland?

A

Anterior: hepato-renal pouch and bare area of the liver

Inferior: kidney

Posterior: Diaphragm

Medial: IVC

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5
Q

What are the 3 zones of the prostate?

A
  • Transitional zone: surrounds urethra (most common site for BPH)
  • Central zone: surrounds the ejaculatory duct
  • Peripheral zone: surrounds the other 2 zones (70% of prostatic cancer)
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6
Q

What are the sub divisions of the adrenal cortex and what do they each produce?

A

From superficial to deep

Zona Glomerulosa - Mineralocorticoids e.g. Aldosterone

Zona Fasciculata - glucocorticoids e.g. cortisol

Zona Reticularis - sex hormones e.g. androgens & oestrogen

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7
Q

What is the bony landmark of the vesico-ureteric junction?

A

Ischial spine

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8
Q

What is the relation of the ureter to the gonadal vessels?

A

Lateral, posterior and then medial (at the bifurcation of the common iliac artery)

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9
Q

What is the histological structure of the prostate?

A

Glandular and smooth muscle elements

(does NOT have a true capsule but an outer condensed fibro-muscular band which is an inseparable component)

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10
Q

Which zone of the prostate does BPH most often affect?

A

Transitional zone (medial lobe)

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11
Q

Which zone of the prostate is most often affected during prostate cancer?

A

Peripheral zone (70% of prostate cancers)

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12
Q

What is the blood supply of the prostate?

A

Inferior vesicle artery AND middle rectal artery (anterior division of Internal iliac artery)

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13
Q

What is the venous drainage of the prostate?

A

Prostatic venous plexus of Santorini

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14
Q

In a DRE what will you find antreriorly and posteriorly in males?

A

Anteriorly: prostate

Posteriorly: Puborectalis (part of anal sphincter)

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15
Q

In a PV examination, what will be palpated anteriorly?

A

Base of the bladder

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16
Q

What is the anatomical structure of the bladder and what is their significance?

A

Apex: attached to the median umbilical ligament (if patent can cause urachal sinus)

Neck: lies on prostate (males) or Pelvic fascia (females)

2 postero-superior angles: receives the 2 ureters

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17
Q

What is the trigone?

A

Triangular part at the base between the 2 openings of the ureter and the opening of the urethra

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18
Q

What is the arterial supply of the bladder?

A

Vesical arteries (anterior division of internal iliac artery)

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19
Q

What is the sympathetic and parasympathetic supply of the bladder?

A

Parasympathetic: S2, 3, 4 (motor to wall and relaxation of sphincter)

Sympathetic: T11 - L2 (inhibition of wall and contraction of sphincter)

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20
Q

What is the embryological origin of the urethra and what does malformation of this structure cause?

A

Urethra is a subdivision of the Cloaca

Malformation of the cloaca will lead to vesical-ureteric fistula

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21
Q

What is the average lengths of the male and female urethra?

A

Male: 15-20cm

Female: 4cm

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22
Q

How many parts does the male urethra consist of?

A

4 parts

  • Pre-prostatic urethra
  • Prostatic urethra: widest and most dilatable part. receives input from ejaculatory duct
  • Membranous urethra: surrounded by striated external sphincter. Narrowest and least dilatable part
  • Penile urethra: poorly muscularised. Traverses corpus spongiosum to open at tip of glans penis
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23
Q

Which part of the urethra receives input from the ejaculatory duct?

A

Prostatic urethra

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24
Q

What are clinical signs of bladder injury?

A
  • Anuria
  • Puritanism (or at least lower abdominal pain)

Investigated by anterograde cystogram

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25
What are the 2 main sites of urethral injury and how can a diagnosis be made?
- Membranous urethra: high riding prostate Bulba urethra: pt will presents with legs apart Diagnosed by retrograde cystogram
26
What are the 3 layers that cover the spermatic cord?
- External spermatic fascia (ext. oblique aponeurosis) - Cremasteric fascia (int oblique) - Internal spermatic fascia (transversalis fascia)
27
Which vein and structure is involved in formation of a varicocele?
Defect in testicular vein OR Pampiniform plexus (plexus drains into testicular vein)
28
What are the 8 structures that are present in the spermatic cord?
- Vas deferens - Testicular artery (branch of AA) - Artery of vas def - Cremasteric artery (from inferior epigastric artery) - Pampiniform plexus - Sympathetic nerve fibres (lies on arteries) - Genital branch of genitofemoral nerve - lymphatic vessels
29
What are the layers of the scrotum?
From inside to out - Tunica Albuginea (fibrous) - Visceral layer of tunica vaginalis (from peritoneum) Parietal layer of tunica vaginalis (from peritoneum) - Internal spermatic fascia (fascia transversalis) - Cremasteric fascia (Int. oblique) - External spermatic fascia (Ext. oblique) - Dartos muscle - Skin
30
Where does the Tunica vaginalis originate from?
Peritoneum
31
What scrotal layer surrounds a hydrocele?
Tunica vaginalis
32
Where does the Dartos muscle arise from?
Superficial fascia
33
Where would a collection or swelling surrounding the Dartos muscle present?
Subcutaneously
34
What is the lateral sensation of the scrotum supplied by?
Genitofemoral nerve (L1-L2)
35
What is the anterior sensation of the scrotum supplied by?
Ilioinguinal nerve
36
What is the inferior and posterior sensation of the scrotum supplied by?
Posterior: Pudendal nerve (S2- S4) Inferior: Posterior femoral cutaneous nerve
37
What is the lymphatic drainage site of the scrotum?
Superficial horizontal inguinal nodes
38
What is the lymphatic drainage of the testis and ovaries?
Para-aortic nodes (as they receive blood supply from aorta)
39
What is the lymphatic drainage of the scrotum, labia major and lower anus?
Superficial horizontal inguinal lymph nodes
40
What is the most important tendinous support of the uterus?
Central perineal tendon
41
What is the lymphatic drainage of the fundus of the uterus?
- Para-aortic nodes - Inguinal lymph nodes (via round ligament)
42
What is the lymphatic drainage of the body of the uterus?
External iliac node (via broad ligament)
43
What is the lymphatic drainage of the cervix?
- Ext. iliac node - Int. iliac node - Presacral nodes
44
What is the lymphatic drainage of the prostate and bladder?
Internal iliac nodes and then drains into sacral nodes
45
What are the boundaries of the Ischiorectal fossa?
Medial wall: Levator ani muscle and anal canal Lateral wall: Obturator internus (covered with fascia) Base: Skin of perineum
46
What are the contents of the ischiorectal fossa?
- Dense fat - Pudendal nerve and internal pudendal vessels (in the pudendal canal) - Inferior rectal nerve (arises from pudendal nerve) + vessels (cross fossa to reach anal canal)
47
What are the 3 terminal branches of the pudendal artery?
- Inferior rectal artery - Dorsal artery of clitoris - Perineal artery (supplies penis and labia)
48
Where is the deep perineal pouch and what structures are found here?
Area between perineal membrane (below) and superior fascia of urogenital diaphragm (above) Structures found in females: - Vagina - Urethra - Sphincter membrane - dorsal nerve of clitoris (from pudendal) - dorsal/deep arteries clitoral arteries (from pudendal artery) Structures found in males: - Bulbourethral glands (lie below sphincter urethrae muscle. secretions released during erotic stimulation) - Internal pudendal artery (gives rise to artery to bulb, deep artery of penis, dorsal artery of penis) - Dorsal nerve of penis (passes on each side through deep perineal pouch to supply skin of penis)
49
What is the normal pathway of testis descent?
Deep inguinal ring --> Inguinal canal --> Superficial inguinal ring --> Upper part of the scrotum
50
What is the most common site for an ectopic testis?
Superficial inguinal pouch
51
What is the name of the fascia that is found anterior to the rectum between the rectum and prostate?
Denovilliers fascia
52
Where is Waldeyers fascia found?
Posterior ano-rectal
53
What are the features of a female pelvis that differ from a male pelvis?
- Wider and shallower - Ischial tuberosities are further apart - Oval shaped in females - Sacrum is less curved
54
What is the lymphatic drainage of the upper and middle rectum?
Pararectal and Inferior mesenteric lymph nodes
55
What is the lymphatic drainage of the lower rectum?
Sacral group OR Internal iliac lymph nodes
56
What is the lymphatic drainage of the anal canal below the dentate line?
Inguinal and external iliac nodes
57
What is the lymphatic drainage of the anal canal above the dentate line?
Mesorectal / Internal iliac nodes
58
What is the origin and termination of the abdominal aorta?
T12 to L4
59
What are the anterior relations of the abdominal aorta?
- Lesser omentum - Liver - Left renal vein - Inferior mesenteric vein - 3rd part of the duodenum - Pancreas - Parietal peritoneum - Peritoneal cavity
60
What are the right lateral relations of the abdominal aorta?
-Right crus of the diaphragm - Cisterna chyli - IVC (becomes posterior distally)
61
What are the left lateral relations of the abdominal aorta?
- 4th part of the duodenum - Duodenal-jejunal flexure - Left sympathetic trunk
62
At which level does the phrenic arteries arise?
T12 (upper)
63
At which level does the coeliac axis arise?
T12
64
At which level does the median sacral and common iliac artery arise?
L4
65
What is the course of the common iliac artery?
Begins at L4, travels downwards laterally at the medial border of the psoas muscle. Ends at the sacroiliac joint where it divides into Int and Ext
66
What is the course of the external iliac artery and what are its branches?
Begins at the sacroiliac joint and ends at the mid-inguinal point where it continues as the femoral artery of the thigh Branches: - Inferior epigastric artery (medial wall of internal ring) - Deep circumflex iliac artery
67
Where does the IVC originate and end?
Begins at L5 (union of common iliac veins behind the RIGHT common iliac artery Ends at the level of T8 (pierces central tendon of the diaphragm)
68
At T8, which structures drain into the IVC?
Hepatic vein Inferior phrenic vein
69
At which level do the suprarenal and renal veins drain into the IVC?
L1
70
Which veins unify to become the portal vein?
SMV and splenic vein
71
In the correct order, from superficial to deep, what layers do you pass through during an LP?
At level L4/L5 - Skin, fat, fascia - Supraspinous ligament - Interspinous ligament - Ligamentum flavum (strongest ligament) - Posterior longitudinal ligament - Epidural space - Dura matter - Arachnoid matter - CSF
72
Which part of the urethra is almost entirely covered by Buck's fascia?
Spongiose part
73
What structure is found immediately anterior to the uterine wall?
Anterior leaf of broad ligament
74
What part of the bladder lies anterior to the cervix?
Fundus (base) of the bladder
75
What anatomical structure lies anterior to the uterine cervix?
Pubocervical ligament
76
What supplies Meckel's diverticulum?
SMA

MRCS Part A (KF edition) (22 decks)

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