Anatomy Flashcards
1
Q
Where is the female reproductive system found?
A
Lies within both the pelvic cavity and the perineum
2
Q
Which parts of the female reproductive system are found in the pelvic cavity?
A
- ovaries
- Uterine tubes
- Uterus
- Superior part of vagina
3
Q
Which parts of the female reproductive system are found in the perineum?
A
- inferior part of vagina
- Perineal muscles
- Bartholin’s glands
- Clitoris
- Labia
4
Q
which parts of the female reproductive system are connected to the parietal peritoneum?
A
floor of peritoneal cavity
roof over pelvic organs
5
Q
what is the role of the parietal peritoneum?
A
covers the superior aspect of organs e.g. bladder, uterus and rectum
6
Q
what pouches does the parietal peritoneum create?
A
vesico-uterine (utero-vesico) - between bladder and uterus
recto-uterine (pouch of douglas) - between uterus and rectum
7
Q
what is the broad ligament?
A
double layer of the peritoneum
extends between the uterus and the lateral walls and floor of the pelvis
helps maintain the uterus in its correct midline position
contains within it the uterine tubes and the proximal part of the round ligament
8
Q
what is the round ligament
A
it is an embryological remnant
attaches to the lateral aspect of the uterus
passes through the deep inguinal ring to attach to the superficial tissue of the female perineum
proximal part is contained within the broad ligament
9
Q
what is the only true organ of the female reproductive system?
A
ovaries - everything else is classed as an accessory organ
10
Q
what are the 3 layers of the uterus body?
A
- Perimetrium (thin outer layer)
- Myometrium (very thick middle layer)
- endometrium (thickens during menstrual cycle then shred in menstruation - inner layer)
11
Q
what are the three parts of the uterus?
A
- Fundus (top part)
- Body (middle part)
- Cervix (lower part) projects into the superior part of the vagina
12
Q
where does implantation of the zygote occur?
A
body of uterus
13
Q
what is it called when the zygote is not implanted in the body of the uterus?
A
ectopic pregnancy
14
Q
what are the 2 most common positions of the uterus?
A
anteverted and anteflexed
15
Q
what is anteverted?
A
cervix tipped anteriorly relative to the axis of the vagina
16
Q
what is anteflexed uterus?
A
uterus tipped anteriorly relative to the axis of the cervix
17
Q
what are the two normal variation positions of the uterus?
A
retroverted and retroflexed
18
Q
What is a retroverted uterus?
A
cervix tipped posteriorly relative to the axis of the vagina
19
Q
what is a retroflexed uterus?
A
uterus tipped posteriorly relative to the axis of the cervix
20
Q
what holds the uterus in position?
A
- strong ligaments e.g. uterosacral ligaments
- endopelvic
- muscles of the pelvic floor e.g. levator ani
21
Q
what does weakness of the uterus support lead to?
A
uterine prolapse - movement of the uterus inferiorly
22
Q
what part of the cervix needs to sampled in a cervical screening?
A
the squamo columnar junction (transformation zone)
23
Q
Where does fertilisation happen in uterine tubes?
A
ampulla
24
Q
what is the opening of the uterine tube called?
A
ostium - where the egg passes from the ovary into the uterine tube
25
what is the role of the fimbriae?
finger like projections which sweep ovum into uterine tubes and along it
26
what is the funnel shape part of the uterine tube called?
infundibulum
27
what is the long part of uterine tubes called?
ampulla
28
what is the thickest walled part of the uterine tube called?
isthmus
29
what is a bilateral salpingo-oophrectomy?
removal of both uterine tubes and ovaries
30
what is a unilateral salpingectomy?
removal of one of the uterine tubes
31
what does the fimbriated end of the uterine tubes open into?
ii. what would this mean?
peritoneal cavity
ii. infection could pass in between the two areas
32
where are the ovaries found?
laterally in the pelvic cavity
33
where do ovaries develop?
posterior abdominal wall and move onto the lateral wall of the pelvis - round ligament of the uterus
34
what do ovaries secrete?
oestrogen and progesterone in response to anterior pituitary hormones FSH and LH
35
what is the vagina?
muscular tube whose walls are normally in contact - except superiorly where the cervix holds them apart forming a fornix
36
what are the four part of the fornix?
anterior
posterior
2x lateral
37
how can the position of the uterus be palpated?
by bimanual palpation
38
what does the palpation of the adnexae do?
can detect large masses or tenderness affecting these structures
39
where can ischial spine be palpated?
laterally
4 and 8 oclock positions
40
what type of muscle is the levator ani?
skeleteal muscle - voluntary control
41
how many muscles is the levator ani muscle made of?
3
42
what is the role of the levator ani muscle?
provides continual support for the pelvic organs
tonic contraction
reflexively contracts further during situations of increased intra-abdominal pressure
43
what nerve supplies the levator ani?
"nerve to levator ani" - s3,4,5 sacral plexus
44
what does the levator ani form the majority of?
pelvic diaphragm - with its fascial coverings
45
what is the perineum?
shallow space between pelvic diaphragm (levator ani)
and the skin
openings in pelvic floor - passage of distal parts of alimentary, renal and reproductive tracts from pelvis to perineum
46
what makes up the 3 points of the urogenital triangle?
1. pubic symphysis
| 2. ischial spine x2
47
what makes up the 3 points of the anal triangle?
1. coccyx
| 2. ischial spine x2
48
what nerve supplies the perineal muscle?
pudendal nerve
49
what is the perineal body?
bundle of collagenous and elastic tissue into which the p[perineal muscles attach
important to pelvic floor strength
can be disrupted during labour
located just deep to skin
50
what are bartholins glands?
pair of pea-sized glands found just behind and either side of the lips that surround the entrance to the vagina.
can get enlarged glands due to infection
51
what is the surface anatomy of the perineum? (superior to inferior)
1. mon pubis
2. clitoris
3. external urethral orifice
4. labium majus
5. labium minus
6. vestibule
7. vaginal orifice
8. anus
52
what does the female breast from?
superiorly rib 2 - inferiorly rib 6
lateral borders of breasts extend from sternum to mid-axillary line
53
what does the breast lie on?
deep fascia covering pec major and serratus anterior
54
where is the retro mammary space found?
between fascia and breast
55
what are the four quadrants of the breast?
upper outer
upper inner
lower outer
lower inner
56
where does most lymph from the breast drain into?
breast drains into the ipsilateral axillary lymph nodes and then to the supraclavicular nodes
57
where can lymph from inner breast quadrants drain into?
parasternal lymph nodes
58
where else can the lower inner breast quadrant drain to?
abdominal lymph fluid
59
where can lymph from the upper limb drain into?
axillary lymph nodes
60
what are the 3 levels of the axillary nodes?
ii. what relation are these levels of the nodes related to?
level I - inferior and lateral to pectoralis minor
level II - deep to pectoralis minor
level III - superior and medial to pectoralis minor
ii. the pectoralis minor
61
what does the axilla consist of?
brachial plexus branches
axillary artery and axillary vein
axillary lymph nodes
all embedded in axillary fat
62
what is the role of the pelvic floor?
separates pelvic cavity from perineum
plays important role in providing support to pelvic organs
plays an important role in maintaining continence
63
what are the three layers of the pelvic floor?
1. pelvic diaphragm
2. muscle of perineal pouches
3. perineal membrane
64
what is the pelvic diaphragm?
deepest layer of the pelvic floor - most internal layer of the pelvic floor
65
what are the two muscle groups of the pelvic diaphragm?
levator ani
coccygeus
66
what does the pelvic diaphragm allow passage for?
male: passage for urethra
female: passage for vagina
67
what are the 3 muscles which make up the levator ani?
puborectalis - most medial
pubococcygeus
iliococcygeus - most lateral
68
what does the levator ani attach to?
pubic bones
ischial spines
tendinous arch of levator ani
perineal body, coccyx and walls of organs in midline
69
what else gives additional support to the pelvic floor?
1.endo-pelvic fascia
Some loose areolar tissue
some fibrous
collagen and elastic fibres
2. pelvic ligaments
fibrous endo-pelvic fascia
uterosacral
transverse cervical
lateral ligament of bladder
lateral rectal ligaments
70
where is the deep perineal pouch found?
lies below the fascia covering the inferior aspect of the pelvic diaphragm
lies above the perineal membrane
71
what does the deep perineal pouch contain?
contains part of the urethra and (vagina in females),
bulbourethral glands in male
neurovascular bundles for penis/clitoris
extensions of the ischioanal fat pads and muscles
72
what is the perineal membrane?
superficial to deep perineal pouch
thin sheet of tough, deep fascia
contains openings for the urethra (and vagina in females)
73
where is the superficial perineal pouch found?
lies superficial to the perineal membrane
74
what does the superficial perineal pouch contain?
| FEMALE EDITION
female erectile tissue and associated muscle:
clitoris and crura - corpus cavernosum
bulbs of vestibule - paired
associated muscles - bulbospongiosus and ischiocavernous
also contains:
greater vestibular glands
superficial transverse perineal muscle
branches of internal pudendal vessels
pudendal nerve
75
what does the superficial perineal pouch contain?
| MALE EDITION
contains root of penis:
bulb - corpus spongiosum, crura - corpus cavernosum
associated muscles - bulbospongiosus and ischiocavernosus
also contains:
proximal spongy urethra
superficial transverse perineal muscle
branches of internal pudendal vessels
pudendal nerve
76
what is the perineal body important for?
in aiding in support for pelvic floor
77
what are the functions of the pelvic floor?
provides support to the pelvic organs:
normally tonically contracted
helps maintain continence
urinary: external urethral pshincted, compressor urethrae, levator ani
Faecal: tonic contraction of puborectalis bends the anorectum anteriorly
active contraction maintains continence after rectal filling
78
give examples of what might cause injury to the pelvic floor?
1. pregnancy
2. childbirth: stretching or tearing and pudendal nerve damage
3. chronic constipation
4. obesity
5. heavy lifting
6. Chronic cough or sneeze
7. previous injury to pelvis/pelvic floor
8. menopause
79
what does the urinary continence depend on?
urinary bladder neck support
external urethral sphincter
smooth muscle in urethral wall
80
what is a prolapse?
common gynaecological disorder which can involve the utereus, vagina or both
due to failure of support for pelvic organs
81
what is a vaginal prolapse?
herniation of urethra, bladder rectum or rectouterine pouch through supporting fascia
presents as a lump in vaginal wall
82
how do you manage a vaginal prolapse?
1.sacrospinous fixation:
sutures placed in sacrospinous ligament
to repair cervical/ vault descent
performed vaginally
risk of injury to pudendal NVB and sciatic nerve
2. Incontinence surgery:
Trans-obturator approach
mesh through obturator canal
space in obturator foramen in passage of obturator NVB
create a sling around the urethra
incision through vagina and groin
83
when do anatomical and morphological indications of male or female present in an embryo?
7th week
84
what the two genital ducts both male and females have during embryonic development?
mesonephric (wollfian) duct
Paramesonephric (mullerian) duct
85
what are the major components found in the lateral pelvic wall?
1. Peritoneum
2. ureter
3. Vas deferens/round ligament of the uterus
4. common iliac artery + branches
5. common iliac veins + branches
6. Sacral plexus nerves + others
7. lymphatics
8. number of muscles
86
what bones and ligaments would be found in the lateral pelvic wall?
ligaments:
1. sacrospinous ligament - runs from sacrum on to the ischial spine
2. sacrotuberous ligament - runs from sacrum down to the tuberosity
3. obturator membrane
bones:
1. ilium
2. ischium
3. pubis
87
what muscles are found in the lateral pelvic wall?
1. levator ani
2. tendinous arch of levator ani
3. piriformis
4. coccygeus
5. obturator internus
88
what are the arteries are found in the lateral pelvic wall?
1. Abdominal aorta
2. inferior mesenteric
3. superior rectal
4. internal iliac
5. external iliac
6. Gonadal artery
89
which are the two main arteries which are not supplied by the internal iliac artery?
1. Gonadal artery - directly branches off the abdominal aorta
2. superior rectal artery - continuation of the inferior mesenteric artery
90
what arteries are found in the female pelvis?
1. common iliac artery
2. internal iliac artery
3. obturator artery
4. uterine artery
5. internal pudendal artery
6. middle rectal artery
7. superior vesical arteries
91
where do anastomosis occur in the female artery?
1. between the uterine artery and the ovarian artery
| 2. between the uterine artery and the vaginal artery
92
what arteries are found in the female perineum?
1. common iliac
2. internal pudendal artery
3. inferior rectal artery
4. inferior rectal artery
5. perineal artery
6. labial arteries
7. dorsal artery of clitoris
93
what arteries are found in the male pelvis?
1. common iliac artery
2. internal iliac artery
3. gluteal arteries
4. obturator artery
5. internal pudendal artery
6. middle rectal artery
7. prostatic branch of inferior vesical artery
8. superior and inferior vesical arteries
94
what are the arteries found in the male perineum?
1. internal pudendal artery
2. dorsal artery of penis
3. perineal artery
4. posterior scrotal artery
5. deep artery
6. anterior scrotal artery
95
where do the veins of the pelvis and perineum normally drain into?
1. Mainly into internal iliac vein
- some will drain via superior rectal hepatic portal system
- some will drain via lateral sacral veins into internal vertebral venous plexus
96
what are the two main divisions of the internal iliac artery found in the pelvis?
anterior division - supplies viscera of pelvis and perineum
posterior division - supplies body wall
97
what nerves are found in the lateral pelvic wall?
1. obturator nerve
2. sciatic nerve
3. pudendal nerve - formed by the sacral plexus
4. nerve to levator ani
5. sacral plexus
6. pelvic splanchnic nerves
98
what are the lymphatics of the pelvis?
1. lumbar lymphatics
2. inferior mesenteric lymphatics
3. sacral lymphatics
4. pararectal lymphatics
5. deep inguinal lymphatics
6. superficial inguinal
7. external iliac
8. internal iliac
99
describe the route of lymph drainage from superior pelvic viscera?
external iliac nodes - common iliac - aortic - thoracic duct - venous system
100
describe the route of lymph drainage from inferior pelvic viscera?
deep perineum - internal iliac nodes - common ililac - aortic - thoracic duct into venous system
101
describe the route of lymph drainage from superficial perineum
superficial inguinal nodes
102
what is transperitoneal spread?
disease can penetrate through the peritoneal layer and disseminate into the peritoneal cavity
103
what are the functions of the bony pelvis?
1. support of the upper body
2. transference of weight
3. Attachment for muscles
4. Attachment for external genitalia
5. Protection of pelvic organs
6. passage for childbirth
104
what does the bony pelvis consist of?
1. 2 hip bones
2. sacrum
3. coccyx
105
Each hip bone is a fusion between....?
1. ilium
2. ischium
3. pubis
106
what does the ilium consist of?
1. iliac crest - runs between ASIS and PSIS
2. iliac fossa - internal aspect of the ilium. attachment site of iliacus muscle
3. ASIS - anterior superior iliac spine. the anterior end of the iliac crest
4. PSIS - posterior superior iliac spine
107
what does the ischium consist of?
1. ischiopubic ramus - part of ischium and pubis
2. ischial spine
3. ischial tuberosity
108
What does the pubis consist of?
1. ischiopubic ramus
2. superior pubic ramus
3. pubic arch - where the ischiopubic rami meet. forms the subpubic angle
109
what does the pelvic inlet consist of?
1. closed posteriorly by the sacral promontory
2. closed anteriorly by the pubic symphysis
3. ilium
4. superior pubic ramus
110
what does the pelvic outlet consist of?
1. coccyx
2. pubic symphysis
3. ischiopubic ramus
4. ischial tuberosities
5. sacrotuberous ligaments
111
where is the pelvic cavity found?
lies within the bony pelvis
continuous with abdominal cavity above
lies between pelvic inlet and pelvic floor
112
What are the palpable surface landmarks of the pelvis
Anterior
1. iliac crest
2. ASIS
3. Pubic symphysis
4. Pubic tubercle
posterior
1. iliac crest
2. PSIS
3. ischial tuberosity
4. sacrum
5. coccyx
the ischial spines are palbable on vaginal examination : approx 4 and 8 o clock positions
113
what does the inguinal ligament attach?
ASIS and the pubic tubercle
114
what are the joints of the pelvis?
Sacroiliac joint - connects sacrum and ilium. synovial joint more anteriorly and syndesmosis joint more posteriorly.
hip joint - head of femur and the acetabular of the hip bone (synovial)
Pubic symphysis - (secondary cartilaginous) joint between the left and right superior rami of the pubis of the hip bones
115
what are the two main ligaments of the pelvis?
1. sacrotuberous ligament - runs between sacrum and ischial tuberosity (posterior)
2. sacrospinous ligament - runs between sacrum and ischial spine (anterior)
116
what are the functions of the ligaments of the pelvis?
1. protections against sudden weight transfer - ligaments relax during pregnancy
2. presence of these 2 ligaments also from 2 foraminae: greater and lesser sciatic foraminae
117
what is the obturator foramen?
a large opening in the hip bone between the pubis and the ischium.
it is mainly covered by the obturator opening apart from the obturator canal were the obturator NVB passes through. The membrane is covered internally by the obturator internus
118
why is trauma very dangerous in the bony pelvis?
common iliac artery and its branches (same with the common iliac vein) as well as the organs are all in close approximation to the bone. Damage to the bones could easily lead to life threatening damege to the organs
119
The AP and transverse diameters of the female pelvis are larger than the male both at the pelvic inlet and pelvic outlet true or false?
true
120
The subpubic angle in the female is wider than the male true or false?
true
121
the pelvic cavity is more shallow in females true or false?
false
122
name the 4 foetal bones
2 frontal
2 parietal
1 occipital
2 temporal
123
what is the name of the 2 sutures on the foetal skull
sagittal - divides the skull into left and right
coronal - 2 sutures one divides frontal from parietal and the other between parietal and occipital
124
what are the names of fontanelle on the foetal skull?
anterior fontanelle - between frontal and the parietal
posterior fontanelle - between the parietal and occipital
125
what does the term moulding mean?
refers to the movemnt of one bone over another to allow the foetal head to pass through the pelvis through labour
126
what does the vertex refer to for the foetal skull?
its an area outlined by the anterior and posterior fontanelles and the parietal eminences
127
the occipitofrontal diameter is longer than the biparietal one true or false?
true - the foetal skull is longer than it is wide
128
at the pelvic inlet which is wider the transverse or AP diameter?
Transverse
129
what does the term station refer to in child birth?
The distance of the foetal head from the ischial spine
negative number - head is superior to the spines
positive number - head is inferior to the spines
130
while descending through the pelvic cavity, the foetal head should:
1. rotate
| 2. be in a flexed position i.e. chin on chest
131
at the pelvic outlet which is wider the transverse or AP diameter?
AP diameter
132
how should the baby ideally leave the pelvic cavity?
occipitoanterior position
133
during delivery the foetal head should be in....
extension
134
at the pelvic inlet the foetal should be in what position?
transverse
135
As it descends through the pelvic cavity, the foetal head should....?
rotate and be flexed
136
at the pelvic outlet the foetal head should ideally lie ..... and ,,,,, of the head on the neck ?
occipitoanterior (OA)
extension
137
what are common O&G surgical incisions?
Lower segment Cesarean section
Laparatomy
laparoscopy
abdominal and vaginal hysterectomy
138
where do the external obliques attach between?
lower ribs, iliac crest, pubic tubercle and linea alba
the fibres run in the same direction as external intercostals
139
where does the transversus abdominis attach between?
the lower ribs, thoracolumbar fascia, iliac crest and linea alba
140
what divides the rectus abdominis ?
tendinous intersections:
divide each one into 3 or 4 smaller muscles
141
what is the linea alba?
formed by the interweaving of the muyscle aponeuroses
runs from the xiphoid process to the pubic symphysis
142
What is the rectus sheath?
ii. what procedure incises this anteriorly?
immediately deep to superficial fascia
combined aponeuroses of anterolateral abdominal wall muscles
surrounds rectus muscles
ii. LSCS
143
what are the layers of the internal surface of the abominal wall from external and internal?
1. external oblique
2. internal oblique
3. transversus abdominis
4. Transversalis fascia
5. extra peritoneal fat
6. parietal peritoneum
7. abdominal organs
144
which directions do the nerves enter to supply the anterolateral abdominal wall
lateral direction
145
the 7th-11th intercostal nerves become?
thoracoabdominal nerves
146
what nerves supply the aneterolateral abdominal wall?
1. thoracoabdominal nerves
2. subcostal (T12)
3. iliohypogastric (L1)
4. ilioinguinal nerve (L1)
147
describe the blood supply to the anterolateral abdominal wall.
1. Anterior abdominal wall
Superior epigastric arteries
continuation of internal thoracic
emerges at supeiror aspect of abdominal wall
inferior epigastric arteries
branch of the external iliac artery
emerges at inferior aspect of the abdominal wall
2. Lateral abdominal wall
intercostal and subcostal arteries
continuations of posterior intercostal arteries
emerge at lateral aspect
148
what happens in an LSCS incision?
the rectus muscles are not cut but are separated from each other in a lateral direction
149
what are the layers which you are opening in a LSCS incision?
1. skin and fascia
2. anterior rectus sheath
3. rectus abdominis
4. fascia and peritoneum
5. retract bladder
6. uterine wall
7. amniotic sac
150
what layers are needed to be stitched in a LSCS?
1. Uterine wall with visceral peritoneum
2. rectus sheath
3. skin
151
what are the layers which you are opening in a laparotomy?
vertical midline incision
1. skin and fascia
2. linea alba
3. peritoneum
152
What layers are needed to be stitched in a laparotomy?
peritoneum and linea alba
fascia skin
153
what are the pro and cons of midline incision?
pro: relatively bloodless
con: increases the chance of wound complications
154
what is a laparoscopy?
sub umbilical incision very minimal
may also require a lateral port but must be taken to avoid the inferior epigastric artery
155
where is the inferior epigastric artery found?
it is a branch of the external iliac artery
emerges just medial to the deep inguinal ring
then passes in asuperomedial direction posteiror to the rectus abdominis
MUST AVOID
156
what is the abdominal hysterectomy?
removal of the uterus via an incison in the abdominal wall
157
what is the vaginal hysterectomy?
Removal of uterus via the vagina
158
how do you differentiate between the ureter and the uterine artery?
ureter passes inferior to the artery - water under the bridge
ureter will often vermicultate when touched.
159
what are the main nerve root values of the nerves supplying the external anal sphincter?
s2,3,4
160
during oogenesis how many rounds of meiosis do cells undergo?
ii. what are they known as in each one?
2
ii. primary oocytes - meiosis 1
secondary oocytes - meiosis 2
161
where does meiosis 1 begin during oogenesis?
in utero
162
when does the cell cycle of the primary oocytes halt?
prophase I
163
what stage are oocytes held in until fertilisation?
metaphase II
