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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

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2
Q

most inferior point in an upright female

A

recto-uterine (pouch of Douglas)

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3
Q

broad ligament

A

double layer of peritoneum
helps maintain uterus in correct midline positions

connects - uterus, fallopian tubes + ovaries to pelvic wall

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4
Q

what does the broad ligament contain

A

ovaries
fallopian tubes
round ligament (proximal part)

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5
Q

3 laers of the uterus body

A

perimetrium
myometrium
endometrium

implantation anywhere else = ectopic pregnancy

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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)

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7
Q

commonest position of uterus

A

anteverted + anteflexed

other = retroverted + retroflexed(tip pointed towards back)

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8
Q

where does fertilisation occur

A

ampulla

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9
Q

salpingo-oophrectomy

A

bilateral = removal of uterine tubes and ovaries

unilateral = removal of one uterine tube

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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

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11
Q

what area must be sampled in a cervical screening?

A

squamo columnar junction (transformation zone)

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12
Q

what type of muscle is levator ani

A

skeletal muscle - voluntary

forms majority of pelvic diaphragm

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13
Q

what supplies levator ani

A

S2, 3, 4 sacral plexus

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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

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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

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16
Q

where does retromammary space lie?

A

between fascia + breats

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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

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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

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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

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20
Q

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

A

abdominal aorta

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21
Q

where does the superior rectal artery arise from?

A
  • continuation of IMA inferior mesenteric artery
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22
Q

artery that males have that females usually dont in pelvis?

A

inferior vesical artery ( they have superior tho)

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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
where does most of the venous drainage in the pelvis + perineum occur?
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
is the ilium in the pelvic inlet or outlet?
inlet, as well as - - superior pubic ramus - pubic symphysis - sacral promontory
27
attachments of inguinal ligament
ASIS -> pubic tubercle
28
what positions of a clock face are the ischial spines palpable on vaginal examination?
4 + 8 o'clock
29
2 key ligaments of pelvis? which foraminae do these form respectively?
sacrotuberous ligament - greater sciatic sacrospinous ligament - lesser sciatic foramen
29
2 key ligaments of pelvis? which foraminae do these form respectively?
sacrotuberous ligament - greater sciatic sacrospinous ligament - lesser sciatic foramen
30
difference in female vs male pelvis
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
vertex of foetal skull
anterior + posterior fontanelles + parietal eminences
32
how is the distance of foetal head from ischial spines described?
referred to as the station - negative number = head superior to spines positive = head is inferior
33
which position should the baby leave the pelvic cavity?
occipitoantierior (OA) - during delivery foetal head should be in extension
34
describe the positions of the foetal head during childbirth
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
how does pain from perineum differ from pain from uterus, vagina and adnexae?
perineum - somatic sensory others - visceral afferents (except perineum part of vagina)
36
innervation to superior aspect of pelvic organs (touching peritoneum)
visceral afferents run alongside SYMPATHETIC fibres enter spinal cord between *T11-L2* pain perceived as SUPRAPUBIC
37
innervation to inferior aspect of pelvic organs (NOT touching peritoneum)
visceral afferents run alongside PARASYMPATHETIC fibres enter spinal cord between *S2, S3, S4* pain perceived IN S2, S3, S4 DERMATOME (PERINEUM)
38
above vs below levator ani innervation
above (in pelvis) - visceral afferents - parasympathetic - s2, 3, 4 below (perineum) - somatic sensory - pudendal nerve - s2,3,4 - localised pain within perineum
39
blood supply to the anterior abdominal wall
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
blood supply to lateral abdominal wall
intercostal + subcostal arteries - continuation of posterior intercostal arteries - emerge at lateral aspect
41
what direction should you incise in in relation to muscle fibres?
same direction minimise traumatic injury
42
incision type use in C-section
LSCS (lower segment caesarean section) - also used for abdominal hysterectomy - vertical midline for laparotomy
43
layers passed when opening for a Csection?
skin + fascia (anterior) rectus sheath rectus abdominas fascia + peritoneum retract bladder uterine wall amniotic sac
44
layers to stitch closed post Csection
uterine wall with visceral peritoneum rectus sheath skin
45
layers when opening for a laparotomy? layers that need stitched closed?
layers when opening - skin + fascia - linea alba - peritoneum layers to stitch close ->all above
46
laparoscopy
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
which artery must be avoided in laparoscopy?
inferior epigastic artery - branch of external iliac - emerges just medial to deep inguinal ring - then passes in superomedial direction posterior to rectus abdominis
48
how can you differentiate from the ureter + uterine artery?
ureter passes inferior to artery ("water under the bridge") ureter often "vermiculates" when touched
49
layers of abdominal wall
external oblique internal oblique transversus abdominis transveralis fascia extra peritoneal fat parietal peritoneum !abominal organs!
50
3 layers of pelvic floor
pelvic diaphragm - levator ani, coccygeus muscles of perineal pouches perineal membranes
51
3 parts of levator ani
illiococcygeus - most lateral pubococcygeus puborectalise - most medial
52
levator Ani innervation
pudendal nerve + nerve to levator ani LA tonically contracted most of time
52
what does the female superficial perineal pouch contain?
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
whats does the male superficial perineal puch contain?
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
prolapse treatment/repair
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

repro (33 decks)

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