Anatomy Flashcards
what aspects of female reproductive tract are located in pelvic cavity
ovaries
uterine tubes
uterus
superior portion vagina
what aspect of female repro tract are located in perineum
inferior vagina perineal muscles bartholins glands clitoris labia
what two pouches does the inferior parietal peritoneum form in females
rectouterine pouch of douglas
vesicouterine
what pouch does the inferior parietal peritoneum form in males
rectovesical
what is the borad ligament of the uterus, what does it do and what does it contain
double layer peritoneu from uterus to lateral walls/floor pelvis
keeps uterus midline
contains prox broad ligament and uterine tubes
what is the round ligament of uterus, what does it attach
embryological remnant
lateral aspect uterus, through deep inguinal ring to superficial tissue perineum
most common uterine position
anteflexed
cervix tipped anterior to vagina
uterus tipped anterior to cervix
true/false - the most common uterine position is retroverted
false - it is normal variation however
during a cervical smear, what aspect of the cervix is smeared
squamocolumnar junction (transition zone) external cervical os sampled
the fact that the uterine tubes are open ended is clinically relevant for what 2 reasons
potential for ectopic pregnancy
potential for infection spread
sections of uterine tube?
infundibulum
ampulla
isthmus
what are the 4 fornix?
anterior
posterior
lateral right/left
nerve to levator ani has what nerve roots?
S3,4,5
surface anatomy of the perineum
mons pubis labia majora labia minora clitoris external urethral meatus vaginal orifice vestibule anus
what do the greater vestibular glands secrete
lubricating fluid
what is the perineal body
bundle of collagenous and elastic tissue where perineal muscles attach
can be damaged by labour
what nerve innervates all muscles of perineum
pudendal
describe how the perineum can be diamond shaped and what triangles it is split into
diamond shaped with points from pubic symphysis to ischial spines, to coccyx
anal triangle and urogenital triangle
on what fascia does the breast lie
deep fascia of pec major and serratus anterior
what ribs do the breast extend from
2-6
what space is between breast and deep fascia
retromammary space
quadrants of the breast?
upper outer upper inner lower outer lower inner axillary tail
if a lump is felt in breast and is fixed it is attached to
deep fascia
if a lump is felt in breast and is mobile it is attached to
breast tissue
lymph drainage of the breast
most are to ipsilateral axillary nodes then onto supraclavicular
inner quadrants can drain parasternal
lower can drain abdominal
if lymph nodes are removed due to breast cancer what upper limb condition can this cause and why
lymphoedema of upper limb as lymph from upper limb can also drain to axillary lymph nodes
level I axillary lymph nodes ?
inferolateral to pec minor
level II axillary lymph nodes?
deep to pec minor
level III axillary lymph nodes?
superomedial to pec minor
blood supply to breast
internal thoracic makes up most
lateral aspect supplied by
thoracic, thoracoacromial, lateral mammary branches by posterior intercostals
venous drainage from breast
axillary vein mainly but also internal thoracic
functions of the pelvic floor
seperates pelvic cavity from perineum
supports organs
continence
what is the urogenital hiatus
gap in pelvic diaphragm to allow passage of urethra and vagina
segments of levator ani and nerve innervation
iliococcygeus
puborectalis
pubococcygeus
levator ani attachments
ichial spines, pubic bones, tendinous arch levator ani
perineal body, coccyx, walls of midline organs
nerve to levator ani and pudendal nerve
what is endopelvic fascia
loose tissue with collagen and elastic fibres
what ligaments support organs within perineum
fibrous endopelvic fascia uterosacral transverse cervical/cardinal lateral ligament of bladder lateral rectal ligaments
what is the deep perineal pouch
lies below fascia covering inferior pelvic diaphragm
above perineal membrane
what structures are found in the deep perineal pouch
part of urethra and vagina
bulbourethral glands (M), neurovascular bundle for penis/clitoris
extension of ischioanal fat pads
what muscles are found in deep perineal pouch
external urethral sphincter
compressor urethrae
deep transverse perineal muscle in men
smooth muscle to replace DTPM in females
what is the perineal membrane
superficial to deep perineal pouch and thin sheet of tough deep fascia
contents of the superficial perineal pouch in females
corpus cavernosum - clitoris and crura - erectile bulbs of vestibule bulbospongiosus and ischiocavernosus bartholins glands superficial transverse perineal muscle pudendal nerve and vessels
contents of the superficial perineal pouch in males
root of penis
corpus spongiosum, corpus cavernosum
bulbospongiosus
ischiocavernosus
perineal support from deep to superficial
pelvic diaphragm deep perineal pouch perineal membrane erectile tissue superficial perineal pouch muscles superficial perineal pouch
what links layers of perineal support
perineal body
muscles maintaining urinary continence?
external urethral sphincter, compressor urethrae, levator ani
muscles maintaining faecal continence?
tonic contraction of puborectalis beds anorectum anterior
active contraction after rectal filling
cause of injury to pelvic floor?
pregnancy childbirth constipation obesity heavy lifting chronic cough previous injury menopause
what is a vaginal prolapse
herniation of urethra, bladder, rectum or rectouterine pouch through fascia
what is a uterine prolapse
descent of cervix/uterus to vaginal wall
1st degree uterine prolapse
cervix dropping to vagina
2nd degree uterine prolapse
cervix drops deeper to vagina but not external
3rd degree uterine prolapse
cervix visible from external and uterus telescoped into vagina
4th degree uterine prolapse
entire uterus present externally
mechanism of repair for uterine prolapse?
sacrospinous fixation
risks injury to sciatic nerve or pudendal NV bundle
what surgery can be given for incontinence
transobturator mesh surgery
very controversial
attachments of the sacrospinous ligament
sacrum
ischial spine
attachments of the sacrotuberous ligament
sacrum
ischial tuberosity
what foramen do the sacrospinous/sacrotuberous ligaments form
greater/lesser sciatic foramen
what covers the obturator foramen
obturator membrane, with gap for obturator NV bundle
tendinous arch of levator ani is made up of what muscle
obturator internus
what is the main arterial supply to the pelvis and what are the main exception
internal iliac
gonadal arteries direct from abdo aorta
superior rectal as continuation of IMA
what are the two main anastomoses in females in the pelvis
uterine artery and ovarian artery
uterine artery and vaginal artery
what does the posterior division of internal iliac supply
body wall
blood to gluteal arteries
what is the significance of the median umbilical ligament
embryological remnant of the umbilical artery which supplied foetus with blood during pregnancy
what are the main divisions of the anterior division of the internal iliac
obturator artery superior vesicle arteries uterine artery/vas deferens internal pudendal artery middle rectal
branches of internal pudendal in females and what else contributes to blood supply to perineum
inferior rectal
dorsal artery clitoris
perineal artery
external iliac
branches of internal pudendal in males
perineal artery
deep artery
dorsal artery penis
anterior scrotal - from external iliac
true/false - hysterectomy can often lead to damage of the ureter
true
what vein does most perineal blood drain to
internal iliac
what are the 2 plexuses that perineal blood can drain to that is of clinical relevance
via superior rectal to hepatic portal
lateral sacral into internal vertebral venous plexus
can be clinically relevant in metastatic disease
nerve roots of obturator nerve and passage through gluteal/perineal area
L2-4
passes on extraperitoneal fatty tissue and into medial thigh by obturator membrane
nerve roots of pudendal nerve and passage through gluteal/perineal area
S2-4
passes through greater sciatic foramen, loops round sacrospinous and back through lesser sciatic foramen
main groups of lymph nodes associated with the pelvis
lumbar inferior mesenteric common iliac internal/external iliac superficial/deep inguinal sacral pararectal
where do the ovaries/testes lymph drain to
lumbar nodes as per embryological origin
where does superficial perineal lymph drain to
superficial inguinal
where does superior pelvic viscera lymph drain to
external iliac nodes, to common iliac, to aortic and to thoracic duct
where does lower pelvic viscera lymph drain to
internal iliac nodes, common iliac, aortic, thoracic duct
what is transperitoneal spread of malignancy
disease penetration of peritoneal layer, leading to dissemination of disease in the peritoneal cavity
