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Human Development 2 > Anatomy 1 > Flashcards

Anatomy 1 Flashcards

1
Q

What are the 3 apertures of the pelvis

A
  • The obturator canal (in the obturator foramen)
  • The greater sciatic foramen
  • The lesser sciatic foramen
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2
Q

what structures pass through the obturator canal

A
  • obturator nerve, artery, vein
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3
Q

what structures pass through the greater sciatic foramen

A
  • superior gluteal neruovascualr
  • inferior gluteal neurovascualr
  • internal pudendal
  • sciatic nerve
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4
Q

what structures pass through the lesser sciatic foramen

A
  • internal pudendal nerve
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5
Q

what does the

  • sciatic nerve innervate
  • pudendal nerve innervate
  • superior gluteal nerve innervate
  • inferior gluteal nerve innervate
A
  • sciatic nerve innervates the posterior compartment of the thigh and the leg
  • pudnednal nerve is the motor and sensory innervation to the pernieum
  • superior gluteal nerve innervates gluteus medius and minimus
  • inferior gluteal nerve innervates gluteus maximus
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6
Q

what are the branches of the pelvic part of the sympathetic trunk

A

i. Gray rami communicantes (which join spinal nerves and are distributed to the periphery
ii. Fibres the join the hypogastric plexus

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7
Q

describe the parasyamptethic supply of the pelvis

A
  • contains fibres originating from S2-S4 the pelvic splanchnic nerves
  • these synapse in the ganglia of the inferior hypogastric plexus or in the walls of the viscera
  • soem firmes ascende through both the inferior and then the superior hypogastric plexus to the inferior mesenteric plexus (hindgut)
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8
Q

describe the superior hypogastric plexus

A

The superior hypogastric plexus is anterior to the sacral promontory.

  • It is a continuation of the aortic plexux and L3 and L4 sympathetic ganglia.
  • It contains sympathetic, sacral parasympathetic (ascending) and visceral afferent fibres.
  • The hypogastric plexus divides inferiorly to form the right and left hypogastric nerves.
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9
Q

describe the inferior hypogastric plexus

A

The inferior hypogastric plexuses lie on either side of the rectum. Each plexus is formed by a hypogastric nerve (from the superior plexus) and from the pelvic splanchnic nerves.

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10
Q

is the descending colon retroperitoneal or intraperiotenal

A

retroperitoneal

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11
Q

is the sigmoid colon intraperiotenal or retroperiotenal

A

intraperitoneal.

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12
Q

where does the sigmoid colon start and where does the rectum start

A

The sigmoid colon starts in front of the pelvic brim. Below it is continuous with the rectum which commences anterior to the 3rd sacral vertebra

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13
Q

how is the sigmoid colon attached to the posterior pelvic wall

A

. It is attached to the posterior pelvic wall by the fan shaped sigmoid mesocolon.

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14
Q

what is the sigmoid colon a common site for

A

The sigmoid colon is a common site for cancer of the large bowel

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15
Q

What happens to the colon in cancer in surgery

A
  • Because the lymphatic vessels drain to inferior mesenteric nodes, an extensive resection of the gut and its associated lymphatics is necessary.
  • The colon is removed from the left colic flexure to the distal end of the sigmoid colon, and the transverse colon is anastomosed with the rectum.
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16
Q

what is a volvulus

A

Because of its mobility, the sigmoid colon can rotate around its mesentery

This may correct itself spontaneously, or the rotation may continue until the blood supply to the sigmoid colon is completely shut off.

The rotation commonly occurs clockwise and is referred to as a volvulus.

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17
Q

what way does a volvulus occur

A

commonly occurs clockwise

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18
Q

what does puborectalis to to the anal canal and rectum

A

The puborectalis portion of the levator ani muscle forms a sling at the junction of the rectum with the anal canal and pulls this part of the bowel forward producing the anorectal angle.

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19
Q

describe the blood supply of the rectum

A

The superior, middle and inferior rectal arteries supply the rectum.

  • The superior rectal artery is a direct continuation of the inferior mesenteric artery.
  • The middle rectal artery is a small branch from the internal iliac artery.
  • The inferior rectal artery is a branch of the pudendal artery.
  • It anastomoses with the middle rectal artery at the anorectal junction.
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20
Q

describe where the

  • superior rectal artery
  • middle rectal artery
  • inferior rectal artery all branch from
A
  • The superior rectal artery is a direct continuation of the inferior mesenteric artery.
  • The middle rectal artery is a small branch from the internal iliac artery.
  • The inferior rectal artery is a branch of the pudendal artery.
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21
Q

describe the peritoneum cover of the rectum

A

The peritoneum covers the anterior and lateral surfaces of the first third of the rectum, and only the anterior surface of the middle third, leaving the lower third devoid of peritoneum.

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22
Q

describe the pathway that the rectum takes

A

The rectum is about 13cm long and begins anterior to the 3rd sacral vertabra as a continuation of the sigmoid colon. It passes inferiorly, following the curve of the sacrum and coccyx, and ends at the tip of the coccyx by piercing the pelvic diaphragm and becoming continuous with the anal canal.

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23
Q

What arteries branch from the umblical artery?

A

x

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24
Q

what structures is involuntary loss of urine after an increase in intra abdominal pressure associated with

A
  • Medial and lateral pubovesical ligaments
  • Pubovesical fascia that the ureterovesical junction
  • Levator ani
  • Functional integrity of the urethral sphincter
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25
Q

what separates the posterior surface of the vagina from the rectum

A

The rectovaginal septum separates the posterior surface of the vagina from the rectum.

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26
Q

describe the ligaments from the uterus

A
  • anterior pelvi wall (pubocervical ligament)
  • lateral pelvic wall (transverse cervical or cardinal ligament)
  • posterior pelvic wall. (uterosacral ligament)
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27
Q

what is the most important ligament

A

The most important of these ligaments are the transverse cervical or cardinal ligaments, which extend lateral from each side of the cervix and vaginal vault to the related pelvic wall

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28
Q

what can uterine prolapse involve the loss of

A

Uterine prolapsed involves loss of support by transverse cervical (i.e. cardinal) or uterosacral ligaments and by levator ani

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29
Q

describe the structure of the empty bladder

A

The empty bladder is shaped like a three-sided pyramid that has tipped over to lie on one of its margin.
- It has an apex, a base, a superior surface and two inferolateral surfaces.

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30
Q

what is the difference between the ovaries and testes develop

A
  • they birth develop high on the posterior wall and descend before birth
  • but unlike the testes the ovaries stop and have a position on the lateral wall of the pelvic cavity
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31
Q

what is each ovary suspended by

A

Each ovary is suspended by a mesentry (mesovarium) that is a posterior extension of the broad ligament.

32
Q

what is the broad ligament a fold of

A

The broad ligament is a peritoneal fold that suspends the uterus and the uterine tubes

33
Q

what suspends the ovaries

A

the ovaries are suspended by the suspensory ligament of the ovary from the lateral pelvic wall and tethered to the uterus by the ovarian ligament.

34
Q

what does the round ligament of the uterus do

A

The round ligament reflects the uterus and keeps it anteverted (forward tilt) and anteflexed (fundus points forward with relation to cervix) as it passes into the inguinal canal ending in the labia majora.

35
Q

what innervates the internal urethral sphincter and external utrehtal sphincters

A

are innervated by spinal cord levels S2-S4

36
Q

describe where the pudnedeal nerve passes

A
  • the pudendal nerve passes out of the pelvic cavity through the greater sciatic foramen and then passes around the ischial spine and through the lesser sciatic foramen
37
Q

what bony landmark can you use to located the pudendal nerve

A
  • ischial spine
38
Q

how can you palpitate for the nerve block for the pudendal nerve

A

The ischial spine can be palpated transvaginally in women and is the landmark for administrating a pudendal nerve block.

39
Q

where does lymphatic drain occur of the pelvic viscera

A

Lymphatics from most pelvic viscera drain mainly into lymph nodes distributed along the internal iliac artery and their associated branches, which drain into nodes associated with common iliac arteries and then into the lateral aortic and lumbar nodes associated with the lateral surfaces of the abdominal aorta.
- These lateral aortic and lumbar nodes drain into lumbar trunks and continue to form the origin of the thoracic duct at the level to T12.

40
Q

How is the ovarian and uterine tubes drained in terms of lymphatics

A
  • lymphatics for the ovaries and uterine tubes leave the pelvic cavity superiorly and drain via vessels that accompany the ovarian vessels directly into the lateral aortic and lumbar nodes online the rest of the pelvic viscera
41
Q

what is the perineum divided into

A

The perineum is divided into an anterior urogenital triangle (urinary and reproductive system) and a posterior anal triangle (anus and external sphincter

42
Q

what is the blood supply and nerve supply to the perineum

A

The internal pudendal artery and pudendal nerve are the major nerve and blood supply to this region.

43
Q

what is the perineal membrane and the deep perennial pouch attached to

A

, the perineal membrane, and the deep perineal pouch, which is attached to the pubic arch.

44
Q

what does the deep perineal pouch contain

A
  • Proximal part of the urethra
  • A mass of smooth muscle (in place of deep transverse perineal muscle in men)
  • Dorsal neurovasculature of the clitoris
  • External urethral sphincter
45
Q

what is between the perineal membrane and the membraneous layer of the sueprifical fascia

A

superficial perineal pouch

46
Q

what does the superficial perineal pouch contain

A
  • Clitoris, crura and associated muscle (ischiocavernosis)
  • Bulbs of the vestibule and surrounding muscle (bulbospongiosis)
  • Greater vestibular glands
  • Deep perineal branch of internal pudendal vessels and nerve
  • Superficial transverse perineal muscle
47
Q

what is the vagina fused with posteriorly and anteriorly

A

The urethra is fused with the anterior wall of the vagina, and posteriorly the vagina is related to the rectum

48
Q

what is the vaignal fornix

A

vaginal fornix is the recess of the margin of the cervix and the vaginal wall.

49
Q

what is the cloisters composed of

A

The clitoris is composed to two corpora cavernosa and the glans clitoris

50
Q

Describe the structure of the clitoris

A
  • the attached part is formed by the root of the clitoris and consists only of the two crura
  • body of the clitoris is formed by an unattached part of the two corpora cavernous, angles posteriorly and is embedded in the connective tissue of the perineum
  • bulbs of the vestibule are attached to the glans clittoris by thin bands of erectile tissue
51
Q

what does stimulation of the parasympathetic fibres carried by splanchnic nerves cause to happen tot he clitoris

A

Stimulation of parasympathetic fibres carried by splanchnic nerves from the anterior rami (S2-S4, which enter the inferior hypogastric plexus) cause specific arteries in the corpora cavernosa to relax, allowing blood filling and clitoral erection.

52
Q

what is the nerovascular supply to the clitoris

A

Arteries supplying the clitoris are branches of the internal pudendal artery, and general sensory information is carried by the pudendal nerve (S2-S4

53
Q

what does the greater vestibular gland do in both males and females

A

greater vestibular gland produces secretion during sexual arousal

54
Q

What is a smear test for

A
  • screen for pre-malignant cervical lesions

-

55
Q

who are smear tests for

A
  • people between the ages of 25-64
56
Q

what is the cause of most cervical cancers

A

HPV

57
Q

name the different types of anaesthesia that you can have

A
  • Spinal anaestehsia
  • pudendal nerve block
  • caudal epidural block
58
Q

Describe spinal anastehsai

A
  • Anaesthetic agent is inserted into the CSF at the L3/L4 spinal level.
  • for C section
  • cannot actively participate in birth
59
Q

describe a pudendal nerve block

A
  • A peripheral nerve block in which the pudendal nerve (S2-S4) is bathed in local anaesthetic agent.
  • limbs are unaffected so they can participate in birth
60
Q

Describe a caudal epidural block

A
  • An in-dwelling catheter is placed in the sacral canal enabling administration of anaesthetic agent to the S2-S4 spinal nerve roots.
  • Further top-ups of anaesthetic can be given if necessary.
61
Q

What are fibroids

A
  • most common cause of benign tumours in women

- binging tumours of uterine smooth muscle and of the surrounding tissue

62
Q

what are the symptoms of fibroids

A

dysmennorhoea, mennorhagia, painful sexual intercourse, urinary frequency and urgency.

63
Q

what locations can fibroids be in

A
  1. Submocasal
  2. Subserosal
  3. Intramural
64
Q

define leiomyoma

A

x

65
Q

Leiomyosarcoma

A

X

66
Q
  1. Dysmennorhoea
A

X

67
Q
  1. Mennorhagia
A

X

68
Q
  1. Myomectomy
A

X

69
Q
  1. Hysterectomy
A

X

70
Q

What are the different types of prolapse

A
  1. Uterine prolapsed
  2. Cystocele – bladder into vagina
  3. Rectocele – rectum into vagina
  4. Enterocele – small bowel into vagina
  5. Urethrocele – urethra into vagina
  6. Vaginal vault – post hysterectomy
71
Q

what can predispose you to prolapse

A
  • delivered large babies
  • long pushing phase of labour
  • smoking
  • obesity
  • connective tissue disorders
  • upper respiratory disorders
  • repetitive strain injuries
72
Q

What are the symptoms of prolapse

A
  • Females often feel a sense of ‘dragging’ or pressure within the vagina,
  • pain during intercourse. .
  • Difficulty passing stool, constipation and even faecal incontinence are symptoms of a rectocele.
  • Incomplete emptying of the bladder and stress incontinence are symptoms of cysto- and uretroceles.
73
Q

what is prolapse more likely to occur with age

A

Prolapse is more likely to occur with age as the supporting structures of the pelvic organs in females are less strong post-menopause as levels of oestrogen are lower.

74
Q

How do you treat prolapse

A

Treatment varies with symptom severity, degree of prolapse and suitability of the patient for surgery.

Often patients require no treatment,

ring pessaries (some of which secrete oestrogen) are an option for moderate symptom severity, and surgery is reserved for more severe prolapses or symptoms.

75
Q

What is stress incontinece

A

Stress incontinence is the loss of small volumes of urine during coughing, laughing, straining or exercisin
- any activity that increases intra-abdominal pressure and results in pressure being transmitted downwards towards the bladde

76
Q

what can increase the risk of urine leakage

A

Physical changes from pregnancy, childbirth and menopause all contribute to weakened pelvic floor muscles and thus increase risk of urine leakage.

77
Q

how do you treat urine incontience

A
  • lifestyle changes
  • weight loss
  • pelvic floor exercise
  • pessaries to elevate the bladder neck and compress the urethra against the posterior aspect of the pubic symphysis
  • surgery - brush colposupsesion or tension free vaginal tape procedure

Human Development 2 (34 decks)

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