Anatomy Flashcards

1
Q

What is the arterial supply of the bladder?

A

branches of the internal iliac:
- superior vesical artery
- vaginal artery
- minor branches gluteal and obturator arteries

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2
Q

What is the venous drainage of the bladder?

A
  • vesicle venous plexus -> internal iliac
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3
Q

What is the nerve supply of the bladder?

A

sympathetic:
- T10-L2
- detrusor relaxation during storage and bladder neck closure

parasympathetic:
- S2-S4
- voiding, i.e. detrusor contraction and relaxation of internal urethral sphincter

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4
Q

Lymphatic drainage of the bladder

A

internal iliac nodes
external iliac nodes
common iliac nodes

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5
Q

bladder wall structure

A

mucosa (transitional epithelium and lamina propria), submucosa, detrusor and adventitia

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6
Q

The plane of the pelvic inlet is at what angle to the horizontal?

A

60 degrees

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7
Q

Which vein does the left ovary drain into?

A

L ovarian vein travels through the suspensory ligament of the ovary and drains into the left renal vein

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8
Q

Which vein does the right ovary drain into?

A

R ovarian vein travels through the suspensory ligament of the ovary and generally joins the IVC

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9
Q

Venous drainage of the uterus

A

uterine vein -> internal iliac vein

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10
Q

Venous drainage of the vagina

A

Vaginal venous plexus -> internal iliac

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11
Q

Fallopian tubes venous drainage

A

Uterine and ovarian veins

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12
Q

cervix venous drainage

A

uterine veins -> internal iliac

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13
Q

small bowel venous drainage

A

hepatic portal vein & superior mesenteric vein -> liver sinusoid

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14
Q

large bowel venous drainage

A

inferior and superior mesenteric veins -> splenic vein and hepatic portal vein

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15
Q

kidney venous drainage

A

renal vein -> ÍVC

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16
Q

ureter venous drainage

A

renal veins and superior and inferior vesical veins -> IVC

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17
Q

venous drainage of spleen

A

splenic vein -> hepatic portal vein

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18
Q

liver venous drainage

A

hepatic vein and hepatic portal vein -> liver sinusoid

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19
Q

pancreas venous drainage

A

pancreaticoduodenal veins, pancreatic veins -> splenic vein

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20
Q

Ascending colon arterial supply

A

Superior mesenteric artery (right colic artery = main branch)

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21
Q

Transverse colon proximal 2/3 arterial supply

A

SMA (middle colic)

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22
Q

Transverse colon distal 1/3 arterial supply

A

Inferior mesenteric artery (ascending branch left colic)

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23
Q

Descending colon arterial supply

A

IMA (left colic)

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24
Q

sigmoid colon arterial supply

A

IMA (sigmoid arteries)

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25
Q

rectum upper 2/3 arterial supply

A

IMA (superior rectal)

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26
Q

rectum lower 1/3 arterial supply

A

Internal iliac (middle rectal)

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27
Q

Anal canal arterial supply

A

Internal pudendal (inferior rectal)

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28
Q

Where does the ovarian artery arise from?

A

Abdominal aorta
(May anastomose with the uterine artery)

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29
Q

Pudendal nerve origins

A

S2, S3, S4

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30
Q

Pudendal nerve terminal branches

A

Inferior rectal nerves
Perineal nerve
Dorsal nerve of the clitoris

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31
Q

Pudendal nerve muscles innervated

A

bulbospongiosus
ichiocavernosus
levator ani muscle group (iliococcygeus, pubococcygeus, puborectalis)
external anal sphincter
female external urethral sphincter

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32
Q

Innervation of the internal and external anal sphincters

A

Internal = innervated by pelvic splanchnic nerves (S4)
- sympathetic contraction,
- parasympathetic relaxation.
External = pudendal nerve (inferior rectal branch) & perineal branch of S4

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33
Q

Obturator nerve entrapment

A

Compression between head of the fetus and bony structures of the pelvis
- sensory loss = upper medal thigh
- motor loss = weakness leg adduction

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34
Q

Common peroneal nerve entrapment

A

Compression lateral head of fibula and leg bars (lithotomy position)
- sensory loss = foot and anterolateral leg
- motor loss = ‘foot drop’, loss of anterior compartment extensors

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35
Q

Lateral femoral cutaneous nerve entrapment

A

Occurs with advancing gestation
= sensory loss only - lateral thigh

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36
Q

Femoral nerve entrapment

A

from pressure from a fetus in a difficult birth
- sensory loss = anterior thigh and knee
- motos loss = quadriceps (SLR) weakness, loss of knee jerk

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37
Q

Testicular cell types

A
  • Sertoli cells = secrete inhibin. Form blood-testis barrier. Have FSH receptors.
  • Leydig cells = secrete testosterone. Have LH receptors.
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38
Q

Arterial supply of the testes

A

Testicular arteries
Cremasteric artery
Artery to vas deferens

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39
Q

Venous drainage of the testes

A

Testicular vein
Pampiniform plexus

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40
Q

Testicular lymphatic drainage

A

lumbar and para-aortic nodes

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41
Q

Testicular innervation

A

Spermatic plexus
T10 spinal segment

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42
Q

Labia Majora innervation

A
  • Pudendal nerve provides cutaenous innervation to posterior external genitalia via one of its terminal branches, the perineal nerve (further branches into posterior labial nerves)
  • The ilioinguinal nerve provides anterior sensation via the anterior labial nerves.
  • The genital branch of the genitofemoral nerve contributes some fibres to the skin of the mons pubis and labia majora.
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43
Q

1st degree tear

A

Laceration limited to superficial perineal skin, vaginal mucosa and frenulum of labia minora

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44
Q

2nd degree tear

A

Extends to perineal muscle and fascia but spares anal sphincter

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45
Q

3rd degree tear - as for 2nd degree, but extends to involve external anal sphincter

A

3A - partial tear anal sphincter < 50% thickness
3B - partial tear anal sphincter >50% thickness
3C - internal sphincter is torn

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46
Q

4th degree tear

A

As for 3rd degree, plus rectal mucosa is torn

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47
Q

Pudendal nerve - roots and course

A

S2,3,4 -> exits the pelvis via the greater sciatic foramen, travels behind the sacrospinous ligament before re-entering the pelvis via the lesser sciatic foramen.

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48
Q

Contents of the greater sciatic foramen

A

Sciatic nerve
Superior gluteal nerve
Inferior gluteal nerve
Pudendal nerve
Posterior Femoral Cutaneous nerve
Nerve to Quadratus femoris
Nerve to obturator internus
Superior gluteal artery and vein
Inferior gluteal artery and vein
Internal pudendal artery and vein
Piriformis muscle

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49
Q

Average diameters within the pelvic inlet

A

Anteroposterior - sacrum to pubic symphysis = 11cm
Oblique - SIJ to iliopectineal eminence = 12cm
Transverse - widest point on the iliopectineal lines = 13cm

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50
Q

Contents of the femoral triangle

A

Femoral nerve and terminal branches
Femoral sheath
Femoral artery and branches
Femoral vein and its proximal tributaries incl SFJ (saphenofemoral junction)
Deep inguinal lymph nodes and lymphatic vessels

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51
Q

Medial umbilical ligament = remnant of what?

A

Remnant of fetal umbilical arteries

52
Q

Median umbilical ligament = remnant of what?

A

Remnant of urachus

53
Q

Inguinal canal - contents and boundaries

A

In females - the round ligament of the uterus + the ilioinguinal nerve.
Posterior wall = transversalis fascia reinforced by conjoint tendon (AKA inguinal falx)
Anterior wall = aponeurosis of external oblique, laterally reinforced by internal oblique.
Floor = inguinal ligament, lacunar ligament, iliopubic tract

54
Q

Ilioinguinal nerve - what spinal segment is it derived from?

A

L1
- one of the most common nerve injuries associated with pelvic surgery
- muscle innervation: transversus abdominis, internal oblique
- sensory: anterior labial nerves

55
Q

iliohypogastric nerve (spinal segments and innervation)

A

segments: T12-L1
- muscle innervation: transversus abdominis, internal oblique
- sensory innervation: upper buttock, skin mons pubis

56
Q

Genitofemoral

A

L1,L2
- muscle innervation: cremaster in males
- sensory innervation: femoral branch L1 (upper proximal thigh)
- genital branch L2 (small area scrotum)

57
Q

Lateral femoral cutaneous

A

L2, L3
Lateral thigh (no motor innervation)

58
Q

Obturator

A

L2-L4
- muscle innervation: obturator externus, adductor longus, adductor brevis, gracilis, pectineus, adductor magnus
- sensory: cutaneous branch (medial thigh)

59
Q

Femoral nerve

A

L2-L4
- muscle innervation: iliopsoas, pectineus, sartorius, quadriceps femoris
- sensory: anterior cutaneous branches (anterior thigh), saphenous (medial lower leg)

60
Q

Autonomic sympathetic nerve supply to the uterus and pelvis is from which spinal nerves?

A

T10 - L1 (inferior hypogastric plexus, AKA pelvic plexus)
- Supplies the uterus and cervix
- Labour pains are therefore referred to these dermatomes (lumbo-sacral region, lower abdomen and loins)
- Labour pain is referred to T11 and T12 in the early stage of labour
- Pain then spreads to adjacent dermatomes, T10 and L1
- Eventually sacral dermatomes S2-S4 are involved during the second stage of labour and delivery

61
Q

Parasympathetic nerves of the vagina and pelvic outlet

A

Pudendal nerve (S2, S3, S4)
Genito-femoral nerve (L1 and L2)
Perineal branch of posterior femoral nerve (L2, L3, and L4)

62
Q

Lymphatic drainage of the vagina

A

Lower vagina -> inguinal nodes
upper vagina -> internal and external iliac nodes

63
Q

Lymphatic drainage of the breast

A

Axillary (75%) and parasternal (25%)

64
Q

Lymphatic drainage of the ovary

A

Para-aortic nodes (primarily lateral aortic nodes)

65
Q

Lymphatic drainage of the fallopian tubes

A

Para-aortic nodes

66
Q

Lymphatic drainage of the cervix

A

external iliac lymph nodes, and ultimately para-aortic lymph nodes

67
Q

Lymphatic drainage of the uterus

A

internal iliac lymph nodes, fundus to para-aortic lymph nodes, lumbar and superficial inguinal lymph nodes

68
Q

Contents of the broad ligament

A

Fallopian tubes
Ovarian artery
Uterine artery
Ovarian ligament
Round ligament of uterus

69
Q

Lumbar plexus - spinal roots

A

contributions from spinal nerves T12-L4
Iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, obturator, femoral

70
Q

Piriformis

A

L5 - S2
origin: sacrum
insertion: greater trochanter
Action: external rotation of the hip
Blood supply: superior and inferior gluteal arteries and lateral sacral arteries

71
Q

Bladder contraction during voiding (micturating) is mediated via innervation of which of the following pathways

A

Parasympathetic fibres from S2, S3, S4 nerve roots (pelvic sphlachnic nerves)
This also causes relaxation of the urethral sphincter (under somatic control)

72
Q

The superficial inguinal ring is an aperture in which structure

A

Aponeurosis external oblique
(the conjoint tendon reinforces the ring posteriorly)

73
Q

Contents of the inguinal canal

A

Round ligament of the uterus + the ilioinguinal nerve

74
Q

Where is the arcuate line and what happens to the rectus sheath either side of it?

A

1/3 of the distance from the umbilicus to the pubic crest.
Above the arcuate line, the rectus is enclosed within the internal oblique (i.e. the internal oblique divides into two lamellae to encompass it). Whereas, below the arcuate line, all the aponeuroses are anterior to the rectus, with transversalis fascia directly behind

75
Q

Cervical lymphatic drainage

A

Primarily drained by external iliac nodes

76
Q

How many seminiferous tubules would you expect to find in a testicular lobule?

A

1-3 seminiferous tubules

77
Q

How many lobules would you expect to find in each testis?

A

250-400

78
Q

Which dermatomes is labour pain referred to in early stage of labour?

A

T11-T12
(then spreads to adjacent T10 and L1 dermatomes as labour progresses)
(Sacral dermatomes S2-S4 are involved during second stage)

79
Q

sympathetic nerves to the uterus and pelvis

A

inferior hypogastric plexus (AKA pelvic plexus) - T10-L1 -> supplies uterus and cx.

80
Q

Parasympathetic nerves to the pelvis

A

Vagina and pelvic outlet are supplied by the pudendal nerve, genito-femoral nerve and perineal branch of the posterior femoral nerve. Pudendal = main contributor (nerve roots S2-S4, hence these dermatomes are involved in second stage).

81
Q

Nerve roots of pudendal nerve

A

S2, S3, S4

82
Q

Nerve roots of genito-femoral nerve

A

L1 and L2

83
Q

Nerve roots of perineal branch of posterior femoral nerve

A

L2, L3, L4

84
Q

Normal functional bladder capacity =

A

400-600mL
First urge to void is typically felt when bladder is approx 150mL full

85
Q

Inferior mesenteric vein drains into

A

Splenic vein

86
Q

Superior mesenteric vein drains into

A

hepatic portal vein

87
Q

Bladder smooth muscle structure

A

3 layers:
inner and outer layers of longitudinal smooth muscle with a middle circular smooth muscle layer

88
Q

The rectus sheath contains:

A

rectus abdominis and pyramidalis muscles

89
Q

Blood supply of the rectum

A

Upper 2/3 = superior rectal (from IMA)
Lower 1/3 = middle rectal (from internal iliac a)
Anal canal = inferior rectal (from internal pudendal a)

90
Q

Superficial perineal pouch (contained between perineal membrane and deep perineal facia) contents: (muscles, other)

A

Muscles:
- Ischiocavernosus
- Bulbospongiosus
- Superficial transverse perineal muscle
Other:
- Crura of clitoris
- Vestibular bulbs
- Greater vestibular glands

91
Q

What is the embryological origin of the round ligament

A

Gubernaculum

92
Q

Describe the course of the round ligament

A

Originates at the uterine horns where the fallopian tubes attach. Leaves the pelvis via deep inguinal ring -> inguinal canal -> attach to mons pubis

93
Q

Pelvic floor muscles

A

Coccygeus + Levator ani
Levator ani = puborectalis, pubococcygeus, iliococcygeal

94
Q

Sensory supply of the clitoris is via branches of which nerve?

A

Pudendal (divides into inferior rectal, perineal and dorsal nerve of the clitoris)
Dorsal nerve of the clitoris = sensory innervation.
Perineal nerve = sensory innervation to skin of labia majora, minora and vestibule

95
Q

Femoral nerve palsy

A

Quadriceps weakness
Anterior thigh sensory disturbance (L3, L4, L5 dermatomes)

96
Q

Ureters receive autonomic supply from which spinal segments?

A

T11 - L2
(Explains ureteric colic giving classic ‘loin to groin’ pain)

97
Q

Arterial supply of the ureter

A

Renal artery
Uterine/vaginal arteries
Gonadal artery (ovarian artery)
Middle rectal artery
Superior vesical artery

98
Q

Numbness and groin pain + sensory deficit in the anterior aspect of the labia - which nerve has likely been damaged during surgery?

A

Ilioinguinal (L1) -> anterior labial nerves

99
Q

What is the inferior border of the deep perineal pouch

A

Perineal membrane (separates the deep and superficial perineal pouches)

100
Q

The testis receive innervation from which spinal segment

A

T10

101
Q

The levator ani are innervated by which spinal nerves?

A

S3/S4 (mainly S4)
- via the pudendal, perineal and inferior rectal nerve.

102
Q

What artery supplies the Levator ani

A

Inferior gluteal artery

103
Q

Which artery is associated with the midgut

A

Superior mesenteric
(Foregut = coeliac trunk, Hindgut = inferior mesenteric)

104
Q

Contents of deep perineal pouch (muscles, other)

A

Muscles:
- Deep transverse perineal muscle
- External sphincter muscle of urethra
- Compressor urethrae muscle
- Urethrovaginal sphincter
Other:
- Proximal portion of urethra
- Bulbourethral glands

105
Q

What type of joint is the pubic symphysis

A

Secondary cartilaginous

106
Q

Boundaries of the femoral triangle

A

Superior: inguinal ligament
Medial: medial border of adductor longus
Lateral: medial border of sartorius
Floor: pectineus, adductor longus and iliopsoas
Roof: fascia lata (cribiform fascia at the saphenous opening)

(Transversalis fascia forms part of the roof of the inguinal canal)

107
Q

How many lobes does the typical breast contain?

A

15-20
alveoli = the basic component of the mammary gland
= lined with milk-secreting cuboidal cells surrounded by myoepithelial cells
Alveoli form groups called lobules.
Lobules form lobes.
Each lobe has a lactiferous duct that drains into openings in the nipple -> each breast typically contains 15-20 lobes

108
Q

Branches of the pudendal nerve:

A

perineal, inferior rectal, and dorsal nerve of the clitoris
(S2, S3, S4)

109
Q

What is the motor function of the pudendal nerve:

A

Innervate the muscles of the perineum and pelvic floor:
- bulbospongiosus and ischiocavernosus muscles
- Levator ani muscle
- external anal sphincter
- External urethral sphincter

110
Q

Contents of the greater sciatic foramen

A

Nerves:
- Sciatic nerve
- Superior and inferior gluteal nerves
- Pudendal nerves
- Posterior femoral cutaneous nerve
- Nerve to quadratus femoris
- Nerve to obturator internus
Vessels:
- Superior gluteal artery and vein
- Inferior gluteal artery and vein
- Internal pudendal artery
Muscles:
- Piriformis

111
Q

Uterine venous drainage

A

Uterine vein -> internal iliac

112
Q

Ovary venous drainage

A

Ovarian vein -> L ovarian into L renal, R ovarian into IVC

113
Q

Vaginal venous drainage

A

Vaginal venous plexus -> hypogastric veins

114
Q

Fallopian tubes venous driange

A

Uterine and ovarian veins

115
Q

Cervical venous drainage

A

Uterine veins -> internal iliac

116
Q

Small bowel venous drainage

A

Hepatic portal vein & superior mesenteric vein -> liver sinusoid

117
Q

Large bowel venous drainage

A

Inferior and superior mesenteric veins -> splenic vein and hepatic portal vein

118
Q

Kidney venous drainage

A

Renal vein -> IVC

119
Q

Ureter venous drainage

A

Renal veins and superior and inferior vesical veins -> IVC

120
Q

Bladder venous drainage

A

Vesical venous plexus -> internal iliac

121
Q

Stomach venous drainage

A

Gastric veins, gastroepiploic veins and short gastric veins -> splenic and SMV

122
Q

Spleen venous drainage

A

Splenic vein -> hepatic portal vein

123
Q

Liver venous drainage

A

hepatic vein and hepatic portal vein -> liver sinusoid

124
Q

Pancreas venous drainage

A

Pancreaticoduodenal veins, pancreatic veins -> splenic vein

125
Q

Testicular blood supply

A

3 arteries:
- testicular arteries (that branch direct from the aorta)
- cremasteric artery (that branches from inferior hypogastric)
- artery to vas deferens (branch of internal iliac)