1. Applied female anatomy Flashcards
What are the branches of the internal iliac artery?
Superior gluteal Inferior gluteal Internal pudendal Umbilical artery Obturator artery Inferior vesical artery Uterine artery Vaginal artery Middle rectal arteries
What does the superior gluteal artery supply?
Gluteus medius and minimus
What does the inferior gluteal artery supply?
Gluteus maximus
What does the internal pudendal artery supply?
Perineum
Where does the ovarian artery branch off of the abdominal aorta?
L2/L3
What artery does the ovarian artery anastomose with?
Uterine artery
What artery does the external artery become and when?
Passes under the inguinal ligament to become the femoral artery
What is the most common location for an ectopic pregnancy?
Ampulla
What are the symptoms of an ectopic pregnancy?
Light vaginal bleeding Nausea and vomiting with pain Lower abdominal pain Sharp abdominal cramps Pain on one side of the body Dizziness or weakness Pain in shoulder, neck or rectum
Why does an ectopic pregnancy present with pain to the shoulder, neck and rectum?
Blood in peritoneal cavity from ectopic pregnancy can go to and irritate the diaphragm
The pain is then referred to the dermatome for C3, 4 and 5 - shoulder, neck and rectum
Where does the uterine artery supply?
Body and fundus of the uterus
Where does the vaginal artery supply?
Cervix and the upper part of the vagina
Where is the vesico-uterine pouch located?
Between the bladder and the uterus
Shallow pouch
Where is the recto-uterine pouch located?
Between the uterus and the rectum
aka. Pouch of douglas
What is the round ligament of the uterus composed of?
The obliterated, old goobernaculum
What are the main supports to the uterus?
The levator ani muscles
Transverse cervical ligaments
Pubocervical ligaments
Sacrocervical ligaments
How do you recognise the transverse/cardinal ligaments?
Main support to the uterus
Positioned horizontally
How do you recognise the pubocervical ligaments
Main support to the uterus
2 firm bands going to the front of the pelvis: from the pubis to the cervix
How do you recognise the sacrocervical ligaments?
Main support to the uterus
Going to the back from the cervix to the sacrum
What passes through the obturator canal?
Obturator artery
Obturator vein
Obturator nerve
What passes through the greater sciatic foramen?
Nerves: Above piriformis: Superior gluteal nerve Below piriformis: Sciatic nerve Inferior gluteal nerve Pudendal nerve Posterior femoral cutaneous nerve Nerve to quadratus femoris Nerve to obturator internus
Vessels:
Superior gluteal artery and vein
Inferior gluteal artery and vein
Internal pudendal artery and vein
Muscle:
Piriformis
What passes through the lesser sciatic foramen?
Tendon of obturator internus
Nerve to obturator internus
Internal pudendal artery and vein
Pudendal nerve
What are splanchnic nerves?
Paired visceral nerves - to the internal organs
Carry fibres of autonomic nervous system (visceral efferent fibres)
Carry sensory fibres from the organs (visceral afferents)
What is the function of the pelvic splanchnic nerves?
S2, S3, S3 splanchnic nerves
Provide parasympathetic innervation to the hindgut - parasympathetic to the pelvis
What is the function of the sacral splanchnic nerves?
Sympathetic innervation to the pelvis
What is the inferior hypogastric plexus formed from?
Formed from hypogastric nerve and the pelvic splanchnic nerve
What is the supply of the superior hypogastric plexus?
Continuation of aortic plexus and L3 and L4 sympathetic ganglia
Contains sympathetic, sacral parasympathetic and visceral afferent fibres
Splits to form hypogastric nerves
What is the blood supply to and from the sigmoid colon?
To: sigmoidal branches of the inferior mesenteric artery (L3)
From: to the inferior mesenteric vein which joins the portal system
What is the nerve supply to the sigmoid colon?
From the hypogastric plexus
The ureter follows the same path as which artery?
The ureter follows the same path as the internal iliac artery
What is a volvulus?
If the sigmoid colon mesentery rotates clockwise around the sigmoid colon and the blood supply is completely shut off
What is the arterial supply to the rectum?
The superior, middle and inferior rectal arteries
Where do the rectal arteries stem from?
Superior rectal - direct continuation of the inferior mesenteric
Middle rectal - small branch from the internal iliac
Inferior rectal - branch of the pudendal
Which arteries anastomose at the anorectal junction?
The inferior rectal artery and the middle rectal artery
Where do the pelvic veins drain to?
Most pelvic veins follow the path of the pelvic arteries and drain into the internal iliac vein
What is the rectovaginal septum?
Septum that separates the posterior wall of the vagina from the rectum
Where is the uterus positioned?
Between the bladder and the rectum
Joins the vagina inferiorly
How does the uterus expand during pregnancy?
Dramatically expands superiorly into the abdominal cavity
What is the cervix?
This is the narrow, inferior portion of the uterus
In which cavity is the uterus positioned and which cavity can it extend to and why?
The uterus is contained mainly in the pelvic cavity
Can expand into the abdominal cavity during pregnancy
Where do the ovaries develop?
Develop high on the posterior abdominal wall
Where are ovaries located at birth?
Ovaries descend down to the lateral wall of the pelvic cavity
Where does the blood supply to the uterus come from?
From the uterine artery - an anterior branch of the internal iliac artery
Where does the blood supply to the ovaries come from?
Ovarian artery from the abdominal aorta at L2/L3
Which artery does the ovarian artery anastomose with?
Ovarian artery anastomoses with the terminal branches of the uterine artery
Where do the ovarian veins drain?
Left - the ovarian vein drains into the renal vein, which then drains into the inferior vena cava
Right - ovarian vein drains directly into the inferior vena cava
What is the perineum?
This is the region between the anus and the scrotum/vulva
What are the boundaries of the perineum?
Pelvic outlet
Superiorly is the pelvic diaphragm i.e. the levator ani and coccygeus muscles
Laterally is the pelvic cavity
What are the divisions of the perineum?
Anterior - urogenital triangle
Posterior - anal triangle
What is contained in the urogenital triangle?
Urinary and reproductive systems
What is contained in the anal triangle?
Anus and external sphincter
What is the blood supply to the perineum?
Internal pudendal artery
Which artery does the uterine artery anastomose with?
Terminal branches of the uterine artery anastomose with the ovarian artery
What is the nervous innervation to the perineum?
Internal pudendal nerve
What is the perineal membrane?
This is a fibromuscular support to the urogenital triangle
What are the deep and superficial perineal pouches?
Superficial perineal pouch - located inferior to the perineal membrane
Deep perineal pouch - located superior to the perineal membrane
Where is the deep perineal pouch located?
This is part of the urogenital triangle
Superior to the perineal membrane
Between the perineal membrane and the pubic arch
What is contained within the deep perineal pouch in females?
Proximal part of urethra
Mass of smooth muscle
Dorsal neurovasculature of the clitoris
Where is the superficial perineal pouch located?
This is inferior to the perineal membrane
Between the perineal membrane and the membranous layer of the superficial fascia
What is contained within the superficial perineal pouch in females?
Contains erectile tissue and associated muscles:
Clitoris and associated muscles (ischiocavernosis)
Bulbs of vestibule and surrounding muscle (bulbospongiosis)
Greater vestibule glands
Deep perineal branch of internal pudendal vessels and nerve
Superficial transverse perineal muscle
What are the components of the clitoris?
Two corpora cavernosa and the glans clitoris
What is the bulb of vestibule?
This is an internal part of the clitoris - an aggregation of erectile tissue
Fill with blood during sexual arousal
What is the nervous innervation to the clitoris?
Parasympathetic splanchnic nerves S2-S4
What is the blood supply to the clitoris?
Branches of the internal pudendal artery
What are the sensory nerves from the clitoris?
Pudendal nerves S2-S4
What are the greater vestibule glands?
Aka. Bartholin’s glands
These produce secretions during sexual arousal
Located in the superior perineal pouch
What is the purpose of a ‘pap’ smear test?
To test for pre-malignant cervical lesions
What is the path of the ureter from the kidney to the bladder?
The ureter passes backwards to the back of the pelvis and then moves forwards to enter the bladder
Where does the uterine artery branch from?
Branches from the internal iliac artery
Where does the vaginal artery branch from?
Branches from the uterine artery
What is the function of the sacrocervical ligaments
These are the posterior support of the uterus
Describe the path of the ureter
Passes over the bifurcation of the common iliac artery, underneath the fallopian tubes and then forwards to the bladder
What is the normal position of the uterus?
Antiverted and antiflexed
What is the pelvic diaphragm/floor composed of?
Levator ani muscles
Coccygeus muscles
Covering fascia
What are general visceral afferents?
These are visceral autonomic sensory nerves
What are the nerve roots of the sympathetic GVAs?
T1-T5 for the thoracic viscera
T5-L2 for the abdomen
What are the nerve roots for the parasympathetic GVAs?
S2-S4
What is spinal anaesthesia?
Anaesthesia during childbirth - will also anaesthetise the legs
Inserted into the spinal cord at L3/L4 level
Complete anaesthesia below the waist
Commonly followed by headache
What is a pudendal nerve block?
Peripheral nerve blood in the pudendal nerve - S2-S4
Anaesthetises the perineum and the lower 1/4 of the vagina
What is a caudal epidural block?
Anaesthetic administered via catheter in the sacral canal
Anaesthetises the nerve roots S2-S4
Top ups can be given if necessary
