Anatomy Flashcards
What areas make up the false and true pelvis?
True pelvis made up of sacrum to pelvic symphises whereas false pelvis is everything inside pelvic inlet area before it gets to true pelvis or pelvic cavity
What is in the pelvic cavity? (4)
ovaries, uterine tubes, uterus and superior part of vagina
What’s in the perineum?
Inferior part of vagina, perineal muscles, bartholin’s glands, clitoris, labia
What is the primary organ of reproduction in the female reproductive system?
Ovaries
What are the two pouches formed by the parietal peritoneum sitting on the pelvic organs in females and what is the one pouch in males ?
Vesicles-uterine pouch and recto-uterine pouch (pouch of Douglas) - females
Recto-vesicles pouch - males
How is fluid drained from the Pouch of Douglas?
Needle passed through posterior fornix of the vagina to drain - culdocentesis
What is the broad ligament & what is it attached to?
Double layer of peritoneum over the uterine tubes that extends between lateral uterus to lateral walls & floor of pelvis
What is the round ligament an embryological remnant of?
Embryological remnant of the gubernaculum
What is the round ligament attached to?
Attaches to lateral aspect of the uterus and then passes through deep inguinal ring to attach to the superficial tissue of the female perineum
WHat is the role of the broad ligament?
Role is to maintain uterus in midline position and contains within it uterine tubes and proximal part of the round ligament
What are the 3 layers of the uterus?
Perimetrium
Myometrium
Endometrium
The most common position of the uterus is Anterverted (cervix tipped anterior to axis of vagina) and anteflexed (uterus tipped anterior to axis of cervix). Retroverted and retroflexed uterus is pathological. True/false?
False- its true most common is anterverted and anteflexed but retroverted and retroflexed is a normal anatomical variation
What zone is sampled in a cervical smear test?
Squamo columnar junction AKA transformation zone
What is the fimbriated (sweep the egg) opening of the uterine tube into the peritoneal cavity called?
Ostium
The funnelled part of the uterine tube after the ostium is called the infundibulum. The next longer part is the ampulla (fertilisation occurs here) and where it meets uterus is called the isthmus. True/false?
True
What is the difference between a bilateral salpingo-oophrectomy and a unilateral saplingectomy?
Bilateral salpingo-oophrectomy is bilateral removal of the uterine tubes and ovaries whereas unilateral salpinectomy is removal of one of the uterine tubes
Where do ovaries develop?
Posterior abdominal wall
What ligaments are attached to the ovaries and helped guide them from posterior abdominal wall to lateral wall position?
Ovarian ligaments which are continuation of round ligament of uterus
What are the four parts of the fornix?
Anterior fornix
Posterior fornix
And 2 lateral fornices
What are the adnexae?
Uterine tubes and ovaries
At which positions in the lateral fornix can you palpate the ischial spines and why is this clincally useful?
4 and 8 o clock
Useful for determining of foetus in labour and adminstering pudendal nerve blocks
What separates the pelvic floor from the perineum?
Pelvic floor muscle
What muscle makes up the majority of the pelvic diaphragm with its fasical coverings?
Levator ani
How does levator ani muscle provide continual support for the pelvic organs?
Its tonically contracted and reflexively contracts during situation of increased intra-abdo pressure
Levator ani is a skeletal muscle. What is its nerve supply?
Nerve to levator ani (S3,S4, S5)
fibres of pudendal nerve (S2,S3,S4)
What are the 4 points of the diamond shape of the perineum that makes up the urogenital triangle and anal triangle?
Pubic symphysis anteriorly, ischial spines laterally and posteriorly coccyx
What nerve are the muscles of the perineum supplied by?
Pudendal nerve
What is the perineal body and what is it’s function?
Bundle of smooth & skeletal muscle, collagenous and elastic tissue to which perineal muscles attach
Function is important to pelvic floor strength
What are Bartholin’s glands?
Greater vestibular glands at the posterior aspect of the opening of vagina and secrete lubricating fluid
What does the vestibule surround?
External uretheral orifice and the vaginal orifice
What ribs do breasts extend to and from?
From ribs 2-6 from lateral border of sternum to mid-axillary line
What is the space in between the breast tissue and pec major and what is its function?
Retromammary space - allows breast tissue to be able to move
How is breast tissue attached to skin?
By suspensory ligaments
What are the lactiferous ducts?
Ducts that have lots of little openings that extend through breast tissue to areolas
What are the four quadrants of the breast used for examination and what is the armpit breast tissue called?
Upper inner, upper outer, lower inner, lower outer
Called the axillary tail of spence
Where does most (>75%) of the breast lymph drain to?
Most drains from ipsilateral axillary lymph nodes and then to supraclavicular lymph nodes
Where can lymph from inner breast quadrants drain?
Into parasternal lymph nods
Where can lymph from the lower inner breast quadrant drain to?
Abdominal lymph nodes
Lymph from where also drains to axillary lymph nodes and why is this clincially revelant?
Lymph from upper limb drains there, relevant because if axillary lymph nodes removed it can lead to lymphoedema
What are the 3 levels of the axillary nodes in relation to pec minor?
Level I - inferior and lateral to pec minor
Level II - deep to pec minor
Level III - superior and medial to pec minor
Which blood vessels supply the breast tissue? (medial and lateral and what is each a branch of)
Main blood supply (especially to medial) is internal thoracic AKA internal mammary which is a branch of the subclavian artery . Lateral aspect is supplied by thoracic and thoracoacromial arteries which are branches of axillary and also branches of posterior intercostal arteries
What is the venous drainage of the breast tissue?
Mainly into axillary vein and some into internal thoracic vein and back to subclavian vein
Pelvic floor separates the pelvic cavity from the perineum. What are the 3 layers of the pelvic floor and which is the deepest (AKA most internal)?
pelvic diaphragm i.e. the muscles(deepest), muscles of perineal pouches, perineal membrane.
What are the two main muscle groups of the pelvic diaphragm?
Levator ani and coccygeus
What are the 3 individual muscles of the levator ani from medial to lateral?
puborectalis, pubococcygeus, iliococcygeus
What is the midline gap between the two medial borders of the levator ani muscles called?
urogenital hiatus
What are the attachments of the puborectalis?
Pubic bone and around rectum
What are the attachments of the pubococcygeus?
Pubic bone, midline organs and coccyx
What are the attachments of the iliococcygeus?
ilium, midline organs and coccyx
What are the attachments of the coccygeus muscles?
ischial spine and sacrum & coccyx
What are the additional tissues that provide support to the pelvic organs along with the pelvic floor muscles?
endo-pelvic fascia & its pelvic ligaments (these are thickened areas of the endo-pelvic fascia)
What is endo-pelvic fascia made of?
Some loose areolar tissue and some fibrous tissue (collagen & elastic)
What are 4 pelvic ligaments that assist the pelvic floor in pelvic organ support?
uterosacral
transverse cervical (cardinal)
lateral ligament of bladder
lateral rectal ligaments
What are the superior and inferior borders of the deep perineal pouch?
superiorly bordered by fascia covering inferior aspect of the pelvic diaphragm and inferiorly bordered by perineal membrane
What does the deep perineal pouch contain? (5)
part of urethra,
neurovascular bundle for penis/clitoris (dorsal vein)
extensions of the ischioanal fat pads,
muscles: external urethral sphincter, compressor urethrae, deep transverse perineal muscle
In females part of the vagina and in males the bulbourethral glands
What is the other name for the bulbourethral gland in males and what is their function?
Caupers gland and function is to produce lubricating fluid for urethra
What are the muscles of the deep perineal pouch and which two are different in male & female?
external urethral sphincter, compressor urethrae, males have deep transverse perineal muscle (skeletal) and women have a similar muscle but is smooth muscle
The perineal membrane is deep to the perineal pouch. i.e. is more internal. True/false?
False - is more superficial and is the last passive support for perineal organs
The superficial perineal pouch lies superficial to the perineal membrane. What are the components of the female erectile tissue in this pouch and what tissue are they made of?
clitoris, crura and bulbs of vestibule (all made of corpus cavernosum)
What are the associated muscles of the erectile tissue in the superficial perineal pouch and where do they lie in relation to the erectile tissue?
bulbospongiosus (over bulb) and ischiocavernosus (over crura) muscles
lie superficial to the erectile tissue
What are 4 more structures in the superficial perineal pouch in females in addition to the erectile tissue and their associated muscles?
Greater vestibular glands, superficial transverse perineal muscle and branches of internal pudendal vessels and pudendal nerve
What are 4 more structures in the superficial perineal pouch in females in addition to the erectile tissue and their associated muscles?
Greater vestibular glands, superficial transverse perineal muscle and branches of internal pudendal vessels and pudendal nerve
What is the male equivalent of Bartholin’s glands (AKA greater vestibular glands?)
Cowper’s glands AKA bulbourethral gland
What are the erectile tissue components of the male in the superificial perineal pouch?
bulb and crura both made of corpus cavernosum tissue
What are the associated muscles of the erectile tissue of the males in the superficial perineal pouch?
ischiocavernosus and bulbospongiosus
What are the 4 additional structures in the male superficial perineal pouch?
proximal spongy urethra, superficial transverse perineal muscle and branches of internal pudendal vessels and pudendal nerve
What are the 4 layers below the pelvic floor muscles from deep to superficial & what links all of these layers?
pelvic floor muscles deep perineal pouch perineal membrane superficial perineal pouch including erectile tissue then associated muscles Linked by perineal body
What 3 muscles mostly help maintain urinary continence?
external urethral sphincter (which bands around urethra and vagina), compressor urethrae and levator ani
What muscle helps maintain faecal continence & how does it do so?
Puborectalis forms a sling around the anorectum junction and is attached at the posterior pubis
Tonic contraction of puborectalis bends the anorectum anteriorly
List some causes of injury to pelvic floor. (7)
Pregnancy Childbirth chronic constipation obesity heavy lifting chronic cough/sneeze menopause
Define vaginal prolapse and how does it present
herniation of urethra, bladder, rectum or rectouterine pouch through supporting fascia
presents as lump in vaginal wall
What is uterine prolapse and what are the 4 degrees
descent of uterus into vagina 1st degree just cervix 2nd degree cervix is just inside opening of vagina 3rd degree cervix is outside of vagina 4th degree entire uterus outside vagina
What is used to repair cervical/vault dsecent and what is risk?
Sacrospinous fixation - sutures placed in sacrospinous ligament and uterus
Risk of injury to pudendal nerve neurovascular bundle and sciatic nerve
What is used to repair cervical/vault dsecent and what is risk?
Sacrospinous fixation - sutures placed in sacrospinous ligament and uterus
Risk of injury to pudendal nerve neurovascular bundle and sciatic nerve
What is the surgical treatment for incontinence?
trans-obturator foramen approach: mesh is put through obturator foramen and a sling is made around the urethra
At which point do ovaries contain the greatest number of germ cells?
7 months gestation
