anatomy Flashcards

1
Q

round ligament

A

attache to lateral aspect of uterus
passes through deep inguinal ring to attach to superficial tissue of the female perineum

proximal part in broad ligament
embryological remenant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

most inferior point in an upright female

A

recto-uterine (pouch of Douglas)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

broad ligament

A

double layer of peritoneum
helps maintain uterus in correct midline positions

connects - uterus, fallopian tubes + ovaries to pelvic wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what does the broad ligament contain

A

ovaries
fallopian tubes
round ligament (proximal part)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

3 laers of the uterus body

A

perimetrium
myometrium
endometrium

implantation anywhere else = ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

3 levels of support for uterus

A
  • strong ligaments - uterosacral ligaments
  • endopelvic fascia
  • muscles of pelvic floor - levator ani

–> weakness of these -> uterine prolapse (uterus moves inferiorly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

commonest position of uterus

A

anteverted + anteflexed

other = retroverted + retroflexed(tip pointed towards back)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

where does fertilisation occur

A

ampulla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

salpingo-oophrectomy

A

bilateral = removal of uterine tubes and ovaries

unilateral = removal of one uterine tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

where does the fimbriated end of the uterine tubes actually open into

A

peritoneal cavity

communication between genital tract + peritoneal cavity
-> in theory, infetion could pass between the 2 areas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what area must be sampled in a cervical screening?

A

squamo columnar junction (transformation zone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what type of muscle is levator ani

A

skeletal muscle - voluntary

forms majority of pelvic diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what supplies levator ani

A

S2, 3, 4 sacral plexus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the perineal body?

A

bundle of collagenous + elastic tissue into which the perineal muscle attach
- important to pelvic floor strength
- can be disrupted during labour -> weak pelvic floor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

border of breasts

A

ribs 2-6
lateral border of sternum to mid-axillary line
lies on deep fascia covering pec major + serratus anterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

where does retromammary space lie?

A

between fascia + breats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

where does most lymph from the breast drain to?

A

ipsilateral axillary lymph nodes then to supraclavicular nodes (75%)

lymph from
- inner breast quadrant -> can drain to parasternal lymph nodes
- lower inner -> abdominal lymph nodes
- upper limb -> axillary lymph nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

where can the 3 levels of axillary nodes be found respectively?

A

level I = inferior + lateral to pectoralis minor

level II = deep to pec minor

level III = superior + medial to pec minor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

which artery do the majority of the arteries in the pelvis + perineum arise from? except what?

A

internal iliac

except
- gonadal artery (ovarian, testicular) - abdominal aorta
- superior rectal artery - continuation of IMA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

where do the gonadal artery (ovarian, testicular) arise from?

A

abdominal aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

where does the superior rectal artery arise from?

A
  • continuation of IMA inferior mesenteric artery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

artery that males have that females usually dont in pelvis?

A

inferior vesical artery ( they have superior tho)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

which artery in the male perineum arises from a different location?

A

anterior scrotal artery

others - internal pudendal

24
Q

which artery does the ureter pass under?

A

uterine artery

25
Q

where does most of the venous drainage in the pelvis + perineum occur?

A

internal iliac
- some via superior rectal into hepatic portal system
- some via lateral sacral veins into internal vertebral venous plexus (spinal canal, important in infection spread)

26
Q

is the ilium in the pelvic inlet or outlet?

A

inlet, as well as -
- superior pubic ramus
- pubic symphysis
- sacral promontory

27
Q

attachments of inguinal ligament

A

ASIS -> pubic tubercle

28
Q

what positions of a clock face are the ischial spines palpable on vaginal examination?

A

4 + 8 o’clock

29
Q

2 key ligaments of pelvis? which foraminae do these form respectively?

A

sacrotuberous ligament - greater sciatic

sacrospinous ligament - lesser sciatic foramen

29
Q

2 key ligaments of pelvis? which foraminae do these form respectively?

A

sacrotuberous ligament - greater sciatic

sacrospinous ligament - lesser sciatic foramen

30
Q

difference in female vs male pelvis

A

AP + transverse diameters of female pelvis are larger, both at pelvic inlet + outlet

subpubic angle (+pubic arch) in female is wider

pelvic cavity is more shallow in female

31
Q

vertex of foetal skull

A

anterior + posterior fontanelles + parietal eminences

32
Q

how is the distance of foetal head from ischial spines described?

A

referred to as the station
- negative number = head superior to spines
positive = head is inferior

33
Q

which position should the baby leave the pelvic cavity?

A

occipitoantierior (OA)

  • during delivery foetal head should be in extension
34
Q

describe the positions of the foetal head during childbirth

A

pelvic inlet - tranverse (side)

descent through pelvic cavity - rotate 45 + flexed

pelvic outlet - OA + extended

-> one head delivered, further rotation so shoulders can get through

35
Q

how does pain from perineum differ from pain from uterus, vagina and adnexae?

A

perineum - somatic sensory

others - visceral afferents (except perineum part of vagina)

36
Q

innervation to superior aspect of pelvic organs (touching peritoneum)

A

visceral afferents
run alongside SYMPATHETIC fibres
enter spinal cord between T11-L2
pain perceived as SUPRAPUBIC

37
Q

innervation to inferior aspect of pelvic organs (NOT touching peritoneum)

A

visceral afferents
run alongside PARASYMPATHETIC fibres
enter spinal cord between S2, S3, S4
pain perceived IN S2, S3, S4 DERMATOME (PERINEUM)

38
Q

above vs below levator ani innervation

A

above (in pelvis)
- visceral afferents
- parasympathetic
- s2, 3, 4

below (perineum)
- somatic sensory
- pudendal nerve
- s2,3,4
- localised pain within perineum

39
Q

blood supply to the anterior abdominal wall

A

superior epigastric arteries
- continuation of internal thoracic
- emerges at superior aspect of abdominal wall

inferior epigastric arteries
- branch of external iliac artery
- emerges at inferior aspect of abdo wall

40
Q

blood supply to lateral abdominal wall

A

intercostal + subcostal arteries
- continuation of posterior intercostal arteries
- emerge at lateral aspect

41
Q

what direction should you incise in in relation to muscle fibres?

A

same direction
minimise traumatic injury

42
Q

incision type use in C-section

A

LSCS (lower segment caesarean section)

  • also used for abdominal hysterectomy
  • vertical midline for laparotomy
43
Q

layers passed when opening for a Csection?

A

skin + fascia
(anterior) rectus sheath
rectus abdominas
fascia + peritoneum
retract bladder
uterine wall
amniotic sac

44
Q

layers to stitch closed post Csection

A

uterine wall with visceral peritoneum
rectus sheath
skin

45
Q

layers when opening for a laparotomy? layers that need stitched closed?

A

layers when opening
- skin + fascia
- linea alba
- peritoneum

layers to stitch close ->all above

46
Q

laparoscopy

A

sub-umbilical incision may be all that’s required
if lateral post require, must avoid INFERIOR EPIGASTRIC ARTERY

position of uterus can be manipulated by grasping cervix with forceps inserted via vagina

47
Q

which artery must be avoided in laparoscopy?

A

inferior epigastic artery
- branch of external iliac
- emerges just medial to deep inguinal ring
- then passes in superomedial direction posterior to rectus abdominis

48
Q

how can you differentiate from the ureter + uterine artery?

A

ureter passes inferior to artery (“water under the bridge”)
ureter often “vermiculates” when touched

49
Q

layers of abdominal wall

A

external oblique
internal oblique
transversus abdominis
transveralis fascia
extra peritoneal fat
parietal peritoneum
!abominal organs!

50
Q

3 layers of pelvic floor

A

pelvic diaphragm - levator ani, coccygeus
muscles of perineal pouches
perineal membranes

51
Q

3 parts of levator ani

A

illiococcygeus - most lateral
pubococcygeus
puborectalise - most medial

52
Q

levator Ani innervation

A

pudendal nerve + nerve to levator ani
LA tonically contracted most of time

52
Q

what does the female superficial perineal pouch contain?

A

female erectile tissue + assoc muscles
- clitoris + crura - corpus cavernosum
- bulbs of vestibule - paired
- assoc muscles - bulbospongiosus, ischiocavernosus

gretaer vestibule glands
superficial transverse perineal muscle
branches of internal pudendal vessels
pudendal nerve

53
Q

whats does the male superficial perineal puch contain?

A

root of penis
- bulb - corpus spongiosum
- crura - corpus cavernosum
- assoc muscles - bulbospongiosus, ischiocavernosus

proximal spongy urethra
superficial transverse perineal muscle
branches of pudendal vessels
pudendal nerve

54
Q

prolapse treatment/repair

A

sacrospinous fixation
- sutures placed in sacrospinous ligament
- performed vaginally
- risk to pudendal NVB + sciatic nerve

incontinence surgery
- mesh through obturator canal
- create sling around urethra
- incision through vagina + groin