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Reproduction > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Where does the female reproductive system lie?

A

Within both the pelvic cavity and the perineum

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2
Q

What features of the female reproductive system lie within the pelvic cavity?

A
  • ovaries
  • uterine tubes
  • uterus
  • superior part of vagina
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3
Q

What features of the female reproductive system lie within the perineum?

A
  • inferior part of vagina
  • perineal muscles
  • bartholins glands
  • clitoris
  • labia
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4
Q

What separates the true and false pelvis?

A

Separated by an imaginary line that link sacral promontory and the pubic symphysis anteriorly

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5
Q

What is the only true / primary organ of reproduction in females?

A

Ovary

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6
Q

The inferior part of the parietal peritoneum forms what?

A
  • floor of peritoneal cavity

- roof over pelvic organs

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7
Q

Name the pouches created by the parietal peritoneum in females

A
  • vesico-uterine

- recto-uterine (pouch of douglas)

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8
Q

What is the broad ligament of the uterus composed of and where is it found?

A
  • composed of a double layer of peritoneum

- extends between the uterus and the lateral walls and floor of the pelvis

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9
Q

What is the role of the broad ligament of the uterus and what is contained within it?

A
  • helps maintain the uterus in its correct midline position
  • contains within it the uterine tubes and the proximal part of the round ligament
  • draped over uterine tubes
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10
Q

What is the round ligament of the uterus composed of and where is it found?

A
  • it is an embryological remnant (remnant of gubernaculum)
  • attaches to the uterine horns laterally
  • passes through the deep inguinal ring and the inguinal canal to attach to the superficial tissue of the female perineum
  • specifically the fatty superficial fascia of the labia medura
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11
Q

Name the three layers of the body of the uterus

A
  • perimetrium
  • myometrium
  • endometrium
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12
Q

Where does implantation of the zygote occur?

A

Implantation occurs in the body of uterus

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13
Q

Where does the cervix prroject?

A

Projects into superior aspect of vagina

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14
Q

What is the most common position of the uterus?

A
  • anteverted and anteflexed
  • anteverted; cervix tipped anteriorly relative to the axis of the vagina
  • anteflexed; uterus tipped anteriorly relative to the axis of the cervix (the mass of the uterus lies over the bladder)
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15
Q

Describe normal variations of the position of the uterus

A
  • retroverted and retroflexed
  • retroverted; cervix is tipped posteriorly relative to the axis of the vagina
  • retroflexed; uterus tipped posteriorly relative to the axis of the cervix
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16
Q

The uterus is held in position by what 3 levels of support?

A
  • number of strong ligaments (e.g. uterosacral ligaments)
  • endopelvic fascia
  • muscles of the pelvic floor (e.g. levator ani)
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17
Q

What junction is sampled during cervical smear?

A

The squamo-columnar junction (transformation zone)

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18
Q

The opening into the cervix from the vagina is called what?

A

External cervical os

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19
Q

Where does fertilisation occur?

A

In the ampulla of the uterine tubes

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20
Q

What is a bilateral salpingo-oophrectomy?

A

Removal of both uterine tubes and ovaries

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21
Q

What is a unilateral salpingectomy?

A

Removal of one of the uterine tubes

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22
Q

What is the ostium of the uterine tube?

A

The opening though which the egg will pass from ovary into uterine tube, this opens into the peritoneal cavity

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23
Q

What is the thickest walled section of the uterine tubes?

A

The isthmus

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24
Q

What is the role of hysterosalpingograms?

A

To assess the patency of the uterus and uterine tubes

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25
Q

What do the ovaries secrete?

A

Oestrogen and progesterone in response to anterior pituitary hormones FSH and LH

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26
Q

Where do the ovaries develop and where do they move to?

A
  • develop on the posterior abdominal wall

- move onto the lateral wall of the pelvis

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27
Q

What is the vagina?

A

A muscular tube whose walls are normally in contact (except superiorly where the cervix holds them apart forming a fornix)

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28
Q

What are the four parts of the fornix?

A
  • anterior
  • posterior
  • 2 x lateral
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29
Q

What is the fornix?

A

Space around the cervix, separates cervix from superior vagina

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30
Q

How can the position of the uterus be assessed?

A

By bimanual palpation

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31
Q

What are the adnexae?

A

Both the uterine tubes and ovaries together

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32
Q

Describe palpation of the adnexae

A
  • uterine tubes and ovaries
  • place examining fingers into lateral fornix
  • press deeply with other hand in the iliac fossa on the same side
  • repeat on other side
  • can detect large masses or tenderness affecting these structures
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33
Q

Describe palpation of the ischial spines

A
  • laterally

- 4 and 8 o clock positions

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34
Q

What is the perineum?

A

Shallow space between pelvic diaphragm (levator ani) and the skin

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35
Q

What forms the floor or the pelvis and the roof of the the perineum?

A

The pelvic diaphragm

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36
Q

Where is the perineum found?

A

In the urogenital triangle (pubic symphysis, to ischial spines and then posteriorly to the coccyx)

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37
Q

What type of muscle if levator ani?

A
  • skeletal muscle

- voluntary control

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38
Q

What are the roles of the levator ani muscle?

A
  • forms majority of pelvic diaphragm with its fascial coverings
  • provides continual support for the pelvic organs
  • tonic contraction
  • reflexively contracts further during situations of increased intra-abdominal pressure
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39
Q

What nerve supplies the levator ani muscle?

A
  • S3, 4, 5 sacral nerves

- also fibres from pudendal nerve S2,3,4

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40
Q

The perineal muscles are supplied by what nerve?

A

The pudendal nerve

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41
Q

Describe the perineal body

A
  • bundle of collagenous and elastic tissue into which the perineal muscles attach
  • important for pelvic floor strength
  • can be disrupted during labour
  • located just deep to the skin
  • ball shaped bundle between urogenital and anal triangle
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42
Q

What are the bartholins glands?

A
  • greater vestibular glands
  • located at posterior end of erectile tissue
  • secrete a lubricating fluid
  • roughly pea sized normally
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43
Q

The bed of the female breast extends from where?

A
  • from ribs 2-6

- lateral border of sternum to midaxillary line (axillary tail, extension of fatty tissue)

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44
Q

What lies posterior to the female breast?

A
  • lie on deep fascia covering the pec major and serratus anterior
  • retromammary space lies between fascia and breast
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45
Q

The female breast is firmly attached to the skin via what?

A

Suspensory ligaments

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46
Q

What is the role of the retromammary space?

A

Lets breast tissue move relative to underlying muscle

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47
Q

How are lumps in the female breast described / assessed?

A
  • position is described in relation to the four quadrants or a clock face
  • assess whether it s fixed to any underlying tissue, e.g. the pectoral fascia
  • both the axilla and supraclavicular area should be assessed
  • fixed or mobile can be assessed by asking the patient to put hands on hips to engage pectoral muscles
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48
Q

What are the four quadrants of the breast?

A
  • upper inner
  • lower inner
  • lower outer
  • upper outer
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49
Q

Most lymph (>75%) from the breast drains to where?

A
  • the ipsilateral axillary lymph nodes

- then to the supraclavicular nodes

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50
Q

Lymph from inner breast quadrants can drain to where?

A

The parasternal lymph nodes

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51
Q

Lymph from the lower inner breast quadrant can drain to where?

A

The abdominal lymph nodes

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52
Q

What are the three levels of axillary node clearance?

A
  • all levels are based on the pectoralis minor
  • level one; inferior and lateral to the pectoralis minor
  • level two; deep to pectoralis minor
  • level three; superior and medial to pectoralis minor
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53
Q

What is the blood supply (mainly) to the medial aspect of the female breast?

A
  • branch of the subclavian

- internal thoracic (also called the internal mammary)

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54
Q

What is the blood supply to the lateral aspect of the female breast?

A
  • thoracic and thoracoacromial arteries
  • these are branches of axillary artery
  • also the posterior intercostal artery in the 2nd, 3rd and 4th intercostal spaces (also known as lateral mammary branches)
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55
Q

Describe the venous drainage of the female breast

A
  • drainage mirrors arterial supply, mainly axillary vein and some internal thoracic vein to go back up to subclavian
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56
Q

What separates the pelvic cavity from the perineum?

A

Pelvic floor

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57
Q

What are the three layers of the pelvic floor?

A
  • pelvic diaphragm
  • muscles of perineal pouches
  • perineal membrane
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58
Q

The pelvic floor plays what roles?

A
  • important role in providing support to pelvic organs

- plays an important role in maintaining both faecal and urinary incontinence

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59
Q

What is the deepest layer of the pelvic floor?

A

The pelvic diaphragm

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60
Q

The pelvic diaphragm consists of what and has what appearance?

A
  • consists of two muscle groups; levator ani and coccygeus
  • levaotr ani is more medial and anterior
  • coccygeus is more lateral and posterior
  • has the appearance of a sling
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61
Q

What is the urogenital hiatus?

A
  • anterior gap between the medial borders of the pelvic diaphragm
  • allows for the passage of urethra (both males and females) and vagina
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62
Q

What are the attachment points of the levator ani?

A
  • pubic bones, ischial spines and tendinous arch of levator ani
  • perineal body, coccyx and walls of organs in midline
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63
Q

Name the three parts of levator ani

A
  • puborectalis; most medial, fibres around the rectum area and attached to pubic bone
  • pubococcygeus; pubic bone to midline organs and coccyx
  • iliococcygeus; ileus to coccyx and midline organs
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64
Q

Additional support to the pelvic organs comes from where?

A 
- endopelvic fascia; some loose areolar tissue, some fibrous (collagen and elastic fibres) 
Pelvic ligaments e.g. 
- fibrous endo-pelvic fascia 
- uterosacral (attaches to cervix) 
- transverse cervical (cardinal) 
- lateral ligament of the bladder 
- lateral rectal ligaments
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65
Q

Where does the deep perineal pouch lie?

A
  • lies below the fascia covering the inferior aspect of the pelvic diaphragm
  • lies above the perineal membrane
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66
Q

What does the deep perineal pouch contain?

A
  • contains part of the urethra (and vagina in females)
  • bulbourethral glands in males
  • neurovascular bundle for penis / clitoris
  • extensions of the ischioanal fat pads
  • smooth muscle (females)
  • deep transverse perineal muscle (males)
  • external urethral sphincter
  • compressor urethrae
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67
Q

What do bulbourethral glands screte?

A
  • in males
  • also referred to as cowpers glands
  • secrete lubricating mucus into male urethra
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68
Q

What is the perineal membrane?

A
  • thin sheet of tough, deep fascia
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69
Q

Where the is the perineal membrane located and what are its attachments?

A
  • superficial to deep perineal pouch

- attaches laterally to the sides of the pubic arch, closing the urogenital triangle

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70
Q

Where is the superficial perineal pouch found in both males and females?

A

Lies below the perineal membrane

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71
Q

What is contained within the superficial perineal pouch in females?

A
  • contains female erectile tissue and associated muscle
  • clitoris and crura; corpus cavernosum
  • bulbs of vestibule; paired
  • associated muscles; bulbopsongiosus and ischiocavernosus
  • also contains greater vestibular glands, superficial transverse perineal muscle and branches of internal pudendal vessels and pudendal nerve
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72
Q

What do bartholins glands secrete?

A

Lubricating mucus

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73
Q

The superficial perineal pouch contains what in males?

A
  • contains root of penis
  • bulb; corpus spongiosum, crura, corpus cavernosum -
  • associated muscles; bulbospongiosus and ischiocavernosus
  • also contains proximal spongy (penile) urethra, superficial transverse perineal muscles and branches of internal pudendal vessels and pudendal nerve
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74
Q

Name the layer of the pelvic floor from deep to superficial

A
  • pelvic diaphragm
  • deep peroneal pouch
  • perineal membrane
  • superficial perineal pouch
  • muscles of the superficial perineal pouch
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75
Q

What is the role of puborectalis?

A
  • forms a sling around anorectum junction
  • when contracts creates a bend
  • this prevents faeces from progressing passed this bend
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76
Q

Describe how injury can occur to the pelvic floor

A
  • pregnancy
  • childbirth; stretching or tearing, pudendal nerve damage
  • chronic constipation
  • obesity
  • heavy lifting
  • chronic cough or sneeze
  • previous injury to pelvis / pelvic floor
  • menopause
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77
Q

What does urinary continence depend on?

A
  • urinary bladder neck support
  • external urethral sphincter
  • smooth muscle in urethral wall
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78
Q

Describe a vaginal prolapse

A
  • herniation of urethra, bladder, rectum or rectouterine pouch through supporting fascia
  • presents as a lump in vaginal wall
  • urethrocele, cystocele (bladder herniation), rectocele, enterocele (pouch of douglas herniation)
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79
Q

What are the classic symptoms of uterine prolapse?

A
  • dragging sensation
  • feeling of ‘lump’
  • urinary incontinence
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80
Q

What are the 4 degrees of vaginal prolapse?

A
  • 1st; when cervix is dropping into vagina
  • 2nd; cervix is now dropping to level just inside the opening of the vagina
  • 3rd; cervix is now outside the vagina
  • 4th; entire uterus is outside the vagina
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81
Q

Describe sacrospinous fixation as a treatment of vaginal prolapse

A
  • sutures placed in sacrospinous ligament
  • just medial to the ischial spine
  • to repair cervical / vault descent
  • performed vaginally
  • risk of injruy to pudendal NVB and sciatic nerve
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82
Q

Describe incontinence repair surgery in females

A
  • trans-obturator approach
  • mesh through obturator canal
  • space in obturator foramen for passage of obturator NVB
  • creates a sling around the urethra
  • incisions though vagina and groin
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83
Q

What are the primary male reproductive organs?

A

The testes

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84
Q

Name the male accessory reproductive organs

A
  • the vas deferens
  • seminal glands
  • prostate gland
  • penis
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85
Q

How long is the male urethra?

A

Around 20cm long

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86
Q

What is the most anterior organ of the pelvis in the male?

A

The bladder (when empty)

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87
Q

What are the anatomical relationships of the male bladder?

A
  • in the male, the prostate gland lies inferior to the bladder
  • the rectum lies posteriorly
88
Q

The bladder wall in the male is mainly formed by what?

A

The detrusor muscle

- fibres encircle ureteric orifices and tighten when bladder contracts (prevents reflux of urine)

89
Q

What does the detrusor muscle form around the neck of the bladder in males and what is its function?

A
  • forms the internal urethral sphincter

- contracts during ejaculation to prevent retrograde ejaculation

90
Q

Where do the testes originate and where do they travel to?

A
  • On the posterior wall of the abdominal cavity
  • by birth, they have descended into the scrotum
  • through the anterior abdominal wall (inguinal canal)
91
Q

What is the vas deferns?

A

The tube that sperm pass through follows the testis into the scrotum

92
Q

What is the conjoint tendon?

A
  • the medial end of the combined aponeuroses of internal oblique and transversus abdominis
  • anchors muscles inferiorly to the pubic bone
93
Q

What is the tunica vaginalis?

A
  • inside the scrotum the testis sit within a sac called the tunica vaginalis
  • testis pushes into the tunica vaginalis
94
Q

What is a hydrocele?

A

Excess fluid within the tunica vaginalis

95
Q

Where is sperm produced?

A

Seminiferous tubules

96
Q

What aids in keeping the sperm 1 degree below body temperature?

A

Dartos muscle helps to control temperatue

97
Q

What is the route of sperm?

A
  • sperm pass into the rete testis
  • then into head of epididymis
  • epididymis becomes vas deferens
  • vas deferens passes superiorly in spermatic cord, to deep inguinal ring
  • at deep inguinal ring, the vas deferens turns medially into the pelvis
  • travels posterior to bladder
  • within the pelvis each vas deferens connects with the duct from a seminal gland to form an ejaculatory duct containing semen
  • the right and left ejaculatory ducts join together within the prostate gland and drain into urethra
  • the urethra opens at the external urethral meatus of the penis
98
Q

Where is the epididymis located?

A
  • At the posterior aspect of the testis
  • its proximal end is located at posterior aspect of the superior pole of the testis
  • barely palpable when normal
99
Q

Where can the vas deferens be palpated?

A
  • within the spermatic cord

- in scrotum, superior to testis

100
Q

What are the arterial supply to the testis?

A

Arteries from lateral aspect of abdominal aorta

101
Q

What is the venous drainage of the testis?

A
  • left testicular vein to left renal vein

- right testicular vein to IVC

102
Q

What are the roles of the prostatic urethra?

A
  • drains urine from bladder

- passes semen in ejaculation

103
Q

What is the role of the seminal glands?

A

Produces seminal fluid, rich in fructose

104
Q

What is the role of bulbourethral (cowpers) glands?

A
  • mucus secretion
  • lubricates urethra
  • neutralises acidity
105
Q

Where is the prostate gland found?

A
  • surround the prostatic urethra

- inferior aspect in contact with the levator ani muscle

106
Q

What are the zones of the prostate and which zone is most important clinically?

A
  • peripheral zone and central zone
  • most prostate cancers arise from peripheral zone
  • peripheral zone is the part felt on digital rectal examination
107
Q

What occurs during a vasectomy?

A

The vas deferens is transected and its lumen sutured closed (bilaterally)

108
Q

The root of the penis attaches where?

A
  • the root of the penis laterally attached to the ischium of the pelvis
109
Q

What are the 3 cylinders of erectile tissue in the penis?

A
  • corpus cavernosum right and left; posterior, transmit the deep arteries of penis
  • corpus spongiosum; anteriorly, transmits the spongy urethra, expands distally to form the glans penis
110
Q

Where is the superficial perineal pouch found in males?

A

Lies below the perineal membrane

111
Q

The superficial perineal pouch contains what in males?

A
  • bulb - corpus spongiosum
  • crura - corpus cavernosum
  • associated muscles; bulbospongiosus and ischicavernosus
  • also contains proximal spongy (penile) urethra, superficial transverse perineal muscle and branches of internal pudendal vessels and pudendal nerve
112
Q

What is the blood supply to the penis?

A
  • deep arteries of the penis

- branches from internal pudendal artery from internal iliac

113
Q

What is the blood supply to the scrotum?

A
  • via the internal pudendal and branches from external iliac artery
114
Q

Lymph from scrotum and most of the penis (not glans) drains to where?

A
  • drains to superficial inguinal lymph nodes

- superficial fascia of groin

115
Q

Lymph from the testes drains to where?

A
  • lumbar lymph nodes

- around abdominal aorta

116
Q

If the structure is in the pelvis, what kinds of innervation could be important?

A
  • body cavity so

- sympathetic, parasympathetic and visceral afferents

117
Q

If the structure is in the perineum what kinds of innervation could be important?

A
  • body wall so

- somatic motor and somatic sensory

118
Q

Uterine cramping (e.g. during menstruation) occurs due to what nerve modalities?

A

Hormonal influence of sympathetic and parasympathetics

119
Q

Uterine contractions (e.g. during labour) occurs due to what nerve modalities?

A

Hormonal influence of sympathetic and parasympathetics

120
Q

Pelvic floor muscle contraction (e.g. during sneezing) occurs due to what nerve modalities?

A

Somatic motor

121
Q

Pain from the adnexae (ovaries and fallopian tubes) occurs due to what nerve modalities?

A

Visceral afferents

122
Q

Pain from the uterus occurs due to what nerve modalities?

A

Visceral afferents

123
Q

Pain from the vagina occurs due to what nerve modalities?

A

Visceral afferents (pelvic pain) / somatic sensory (perineum)

124
Q

Pain from the perineum occurs due to what nerve modalities

A

Somatic sensory

125
Q

The superior aspects of the pelvic organs (touching the peritoneum) have what innervation?

A
  • visceral afferents
  • run alongside sympathetic fibres (not in but alongside)
  • enter spinal cord between levels T11-L2
  • pain is perceived by patient as suprapubic
126
Q

The inferior aspects of the pelvic organs (not touching the peritoneum) have what innervation?

A
  • visceral afferents
  • run alongside parasympathetic fibres
  • enter spinal cord at levels S2, S3, S4
  • pain perceived in S2, S3, S4 dermatome (perineum)
127
Q

Pain from structures crossing from pelvis to perineum (e.g. urethra, vagina) above levator ani have what innervation?

A
  • in the pelvis
  • visceral afferents
  • parasympathetic
  • spinal cord levels S2, S3 and S4
128
Q

Pain from structures crossing from pelvis to perineum (e.g. urethra, vagina) below levator ani have what innervation?

A
  • in the perineum
  • somatic sensory
  • pudendal nerve
  • spinal cord levels S2, S3 and S4
  • localised pain within perineum
129
Q

Where do the sympathetics of the pelvis originate?

A
  • sacral sympathetic trunks
  • T11-L2
  • superior hypogastric plexus
130
Q

Where do the parasympathetics of the pelvis originate?

A
  • sacral outflow (S2, S3, S4)
  • pelvic splanchic nerves
  • emerge from spinal roots
  • mixes with sympathetics in inferior hypogastric plexus
131
Q

What is the role of the superior hyogastric plexus?

A

Provides visceral and motor information to the perineum and pelvis

132
Q

What bone is formed by the fusion of the ilium, ischium and pubis?

A

The innominate bone (hip bone)

133
Q

The sacrotuberous ligament runs from where?

A

The sacrum to the ischium tuberosity

134
Q

The sacrospinous ligament runs from where?

A

Sacrum and superior part of coccyx onto ischial spine

135
Q

What forms the greater and lesser sciatic foramen?

A

The sacrospinous ligament

136
Q

Describe the obturator membrane

A
  • partly on lateral wall of pelvis but mostly anterior facing
  • thickened membrane / fascia that almost completely fills the obturator foramen in pelvis
  • allows for passage of obturator neurovascular bundle (obturator canal)
137
Q

Where can the obturator canal be found?

A

On the anterior aspect of the obturator ligament

138
Q

What forms the tendinous arch of levator ani?

A

A band of thickened fascia from the obturator muscle

139
Q

What forms most of the fleshy part of the lateral pelvic wall?

A

Obturator internus

140
Q

The majority of arteries of pelvis and perinuem arise from where?

A

The internal iliac artery

EXCEPT; gonadal artery, superior rectal artery

141
Q

Where does the gonadal artery arise from?

A

Arises around L2 from abdominal aorta, can be testicular or ovarian artery

142
Q

The superior rectal artery is a continuation of what?

A

The inferior mesenteric artery

143
Q

What artery is found in males but not in females (not gonadal)?

A

Inferior vesical artery - this is replaced by the vaginal artery in females

144
Q

The vesicle arteries give off what branches?

A

The prostatic branch and artery to the vas deferens

145
Q

Name the arteries of the male perineum

A
  • dorsal artery of penis
  • deep artery
  • anterior scrotal artery
  • internal pudendal artery
  • perineal artery
  • posterior scrotal artery
146
Q

The internal pudendal artery terminates as what?

A

The dorsal artery of the penis

147
Q

The anterior scrotal artery is a branch of which other artery?

A

The external iliac

148
Q

What is the medial umbilical ligament?

A

Remnant of the umbilical artery which connected the internal iliac artery to the placenta through the umbilical cord

149
Q

What anastamoses occur in the female pelvis?

A
  • an anastamosis occurs between the uterine artery and the ovarian artery
  • an anastamosis occurs between the uterine artery and the vaginal artery
150
Q

What does ‘water under the bridge’ refer to in the female pelvis?

A
  • ureter under the uterine artery

- need to be aware of this during hysterectomy

151
Q

What does vermiculate mean and what structure can do this?

A
  • means it can wiggle

- ureter can do this during surgery, helps to differentiate it from uterine artery

152
Q

Which ureter is most likely to be damaged during hysterectomy and why?

A
  • left
  • right hand side lies a little more laterally and crosses external iliac artery into the pelvis
  • the left sits medially and crosses the common iliac
153
Q

Name the arteries of the female perineum

A
  • common iliac
  • dorsal artery of clitoris
  • labial arteries
  • internal pudendal artery
  • inferior rectal artery
  • perineal artery
154
Q

Describe the venous drainage of the pelvis

A
  • form a number of venous plexuses
  • drain mainly into internal iliac vein however some wil drain via the superior rectal vein back up into the hepatic portal system
  • some will drain via lateral sacral veins into internal vertebral venous plexus
155
Q

What is the clinical significance of the lateral sacral veins of the pelvis?

A

They provide an alternate collateral pathway to the superior or inferior vena cava and it can provide a pathway for metastases

156
Q

Name the nerves of the lateral pelvic wall

A
  • obturator nerve (nothing to do with pelvis but lies on lateral wall)
  • sciatic nerve
  • pudendal nerve
  • nerve to levator ani
  • sacral plexus
  • pelvic splanchic nerves
157
Q

Where do the nerves of the pelvis originate?

A
  • the sacral plexus

- lumbar plexus also joins the sacral plexus

158
Q

Name the somatic nerves of the pelvis

A
  • sciatic nerve
  • pudendal nerve
  • levator ani nerve
  • pelvic splanchic nerves
159
Q

Pelvis splanchic nerves originate where and provide what modality?

A
  • from anterior rami of S2, S3, S4

- carry parasympathetic innervation

160
Q

Name the lymph node groups that can be found in the pelvis

A
  • deep inguinal
  • internal iliac
  • sacral
  • pararectal
  • lumbar
  • inferior mesenteric
  • external iliac
  • common iliac
  • superficial inguinal
161
Q

The superior parts of the pelvic organs / pelvic viscera drain lymph to where?

A
  • external iliac nodes

- then common iliac, aortic, thoracic duct, venous system

162
Q

The inferior parts of the pelvic viscera and areas of the deep perineum drain lymph to where?

A
  • to internal iliac first

- then common iliac, aortic, thoracic duct, venous system

163
Q

The superficial perineum drains lymph to where?

A

To the superficial inguinal nodes

164
Q

The ovaries and testes drain lymph to where and why?

A
  • towards lumbar lymph nodes

- due to embryological origin on posterior abdominal wall

165
Q

Name functions of the bony pelvis

A
  • support of the upper body
  • transference of weight
  • attachment for muscles
  • attachment for external genitalia
  • protection of pelvic organs
  • passage for childbirth
166
Q

The bony pelvis consists of what?

A
  • 2 hip bones (innominate bones)
  • sacrum
  • coccyx
167
Q

Where does the fusion of the three bones of the hip bone occur?

A

Within the acetabulum

  • this occurs during embryological development however complete ossification does not occur until adulthood
168
Q

Name the bony features of the ilium

A
  • iliac crest; palpable, runs between ASIS and PSIS
  • anterior superior iliac spine; anterior end of iliac crest, palpable landmark
  • posterior superior iliac spine
  • iliac fossa; internal aspect of the ilium, attachment of iliacus muscle
169
Q

Name the bony features of the ischium

A
  • ischiopubic ramus; part of both ischium and pubis
  • ischial tuberosity; posteriorly, bony bumps you sit on
  • ischial spine; posterior, important clinical landmark
170
Q

Name the bony features of the pubis

A
  • pubic tubercles; attachment point for inguinal ligament (other attachment being ASIS)
  • come together at pubic symphysis to from pubic arch
  • angle that is located inferior to the pubic arch is known as the sub-pubic angle
  • superior pubic ramus
  • ischiopubic ramus
171
Q

What is the pelvic inlet?

A
  • the entrance to the pelvic cavity proper from the abdominal cavity
  • aka pelvic brim
172
Q

What is the pelvic outler

A

The inferior aspect of the pelvic cavity

173
Q

What makes up the pelvic inlet?

A
  • sacral promontory
  • ilium
  • superior pubic ramus
  • pubic symphysis
174
Q

What makes up the pelvic outlet?

A
  • pubic symphysis
  • ischiopubic ramus
  • ischial tuberosities
  • sacrotuberous ligaments
  • coccyx
175
Q

Name the palpable surface landmarks of the pelvis

A
  • pubic symphysis
  • pubic tubercle
  • ASIS
  • iliac crest
  • sacrum
  • PSIS
  • coccyx
  • ischial tuberosity
  • sacral promontory also palpable on vaginal examination (4 and 8 oclock positions)
176
Q

Name the joints of the pelvis

A
  • hip joint (synovial)
  • pubic symphysis (secondary cartilaginous)
  • hip joint (synovial)
  • sacroiliac joint
177
Q

Describe the sacroiliac joint

A
  • synovial joint
  • often described as synovial anteriorly and a syndesmoses posteriorly (fibrous joint)
  • main function is to transfer weight from the axial skeleton to the hip bones, very little movement occurs here
178
Q

Name the two important ligaments of the pelvis to be aware of

A
  • sacrotuberous ligament

- sacrospinous ligament

179
Q

Where does the sacrospinous ligament run?

A

Runs in relation to bony attachments, sacrum and ischial spine

180
Q

Where does the sacrotuberous ligament run?

A

Between sacrum and ischial tuberosity

181
Q

What is the function of the ligaments of the pelvis?

A
  • protection against sudden weight transfer
  • these ligaments relax after pregnancy
  • ensure the inferior part of the sacrum is not pushed superiorly when weight is transferred anteriorly through the sacral column
  • SI joint moves through a rotational axis, so the joint rotates slightly anteriorly when weight is bearing
182
Q

Under what hormonal influence do the ligaments of the pelvis relax during pregnancy?

183
Q

The presence of the 2 ligaments of the pelvis allows for what foraminae to be formed?

A

The greater and lesser sciatic foraminae

184
Q

What forms the tendinous arch in the pelvis?

A
  • the obturator neurovascular bundle is covered by the obturator internus muscle
  • this is then covered medially by the obturator fascia
  • this fascia thickens centrally to form the tendinous arch
185
Q

The tendinous arch is an attachment point for what?

A

The pelvic diaphragm

186
Q

Describe the differences in male and female bony pelvis

A
  • the AP and transverse diameters of the female pelvis are larger than the male, both at the pelvis inlet and outlet
  • the subpubic angle (and pubic arch) in the female is wider than the male
  • the pelvic cavity is more shallow in the female
187
Q

What is moulding?

A

Refers to the movement of one bone over another to allow for the foetal head to pass through the pelvis during labour

188
Q

What allows for moulding of the foetal skull?

A
  • fontanelles, areas where the bones have not ossified
  • posterior fontanelle; between parietal and occipital bone, triangular shaped
  • anterior fontanelle; frontal and parietal bone, diamond shaped
189
Q

What is the bregma of the foetal skull?

A

The point at which the coronal suture and saggital suture intersect each other, around about the anterior fontanelle

190
Q

What is the vertex of the foetal skull?

A
  • highest point of the skull

- an area of the foetal skull outline by the anterior and posterior fontanelles and the parietal eminences

191
Q

What are the parietal eminences?

A
  • bony bumps on the lateral aspects of the parietal bony
  • points of secondary ossification
  • will eventually smooth over
192
Q

Which diameter is the largest in the foetal skull?

A
  • the occipito-frontal diameter is longer than the biparietal diameter
  • i.e. the foetal head is longer than it is wide
193
Q

What diameter is biggest at the pelvic inlet in females?

A

The transverse diameter of the pelvis is wider than the AP diameter

194
Q

What is the ‘station’?

A
  • the distance of the foetal head from the ischial spines
  • a negative number means the head is superior to the spines
  • a positive number means the head is inferior to the spines
195
Q

Whilst descending through the pelvic cavity, what should the foetal head do?

A
  • rotate

- be in a flexed position, i.e. chin on chest

196
Q

Which diameter is biggest at the pelvic outlet in females?

A

The AP diameter is wider than the transverse diameter

197
Q

During delivery the foetal head should be in what position?

198
Q

At the pelvic inlet, the foetal head should be in what position?

A

Transverse

199
Q

In terms of pain from the female reproductive system, what are the two important spinal cord levels?

A

T11-L2

S2-S4

200
Q

Anaesthetic is injected into where for a spinal or epidural?

A

L3-L4 (L5) region

201
Q

For an epidural anaesthetic, the needle passes through what?

A
  • supraspinous ligament
  • interspinous ligament
  • ligamentum flavum
  • epidural space (fat and veins)
202
Q

For a spinal anaesthetic, the needle passes through what?

A
  • supraspinous ligament
  • interspinous ligament
  • ligamentum flavum
  • epidural space (fat and veins)
  • dura mater
  • arachnoid mater
  • finally reaches subarachnoid space (contains CSF)
203
Q

Why can hypotension occur with spinal anaesthetic?

A
  • all spinal nerves and their named nerves contain sympathetic fibres
  • sympathetic fibres supply all arterioles
  • blockade of sympathetic tone to all arterioles in lower limb leads to vasodilation
  • this leads limb to be warm, skin to be flushed, less sweaty and hypotension
204
Q

The pudendal nerve contains what modalities?

A

Somatic motor and somatic sensory

205
Q

Describe the route of the pudendal nerve

A
  • exits pelvis via greater sciatic foramen
  • passes posterior to sacrospinous ligament
  • re-enters pelvis / perineum via lesser sciatic foramen
  • travels in pudendal canal
  • branches to supply structures of the perineum
206
Q

What landmark is used to locate the pudendal nerve?

A
  • the ischial spine

- the pudendal nerve crosses posterior to the lateral aspect of the sacrospinous ligament

207
Q

When can pudendal nerve blocks be utilised?

A
  • can be used during labour; forceps delivery, painful vaginal delivery, episiotomy incision
  • perineal suturing post delivery
208
Q

What is an episiotomy?

A

Where the skin and perineal muscles are cut in a planned incision

209
Q

Name examples of common obs and gynae surgical incisions

A
  • lower segment caesarean section (suprapubic incision)
  • laparotomy
  • laparoscopy
  • abdominal (and vaginal) hysterectomy
210
Q

Where do the external obliques attach?

A
  • Run antero-inferiorly from aspects of ribs 5-12 to the iliac crest, pubic tubercle
    and linea alba
  • posteriorly is a free edge between costal margins and iliac crest
  • anteriorly the muscle fibres form an aponeurosis at around about midclavicular line and also at the umbilical line
211
Q

What forms the inguinal ligament?

A
  • the thickened inferior edge of external oblique curves back on itself and forms the ligament
  • between ASIS and pubic tubercle
212
Q

Where do the internal obliques attach?

A
  • between lower ribs, thoracolumbar fascia, anterior two thirds of iliac crest and linea alba
  • run in opposite direction to external oblique
  • run in same direction as internal intercostalis
213
Q

Where does transversus abdominus attach?

A
  • between costal cartilage of ribs 7-12 (internal aspects), iliac crest and linea alba
  • deep to internal oblique
  • neurovascular plane lies between internal oblique and transversus abdominus muscle in the anterolateral abdominal wall
214
Q

Where does rectus abdominus lie?

A
  • between 5th to 7th costal cartilage and pubic symphysis and pubic crest
  • 3 times wider superiorly than inferiorly
215
Q

What divides up the rectus abdominus?

A
  • tendinuous intersections

- created improved mechanical efficiency

216
Q

What forms the linea alba and where does it run?

A
  • formed by the interweaving of the muscle aponeuroses

- runs from the xiphoid process to the pubic symphysis

Reproduction (10 decks)

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