Anatomy Flashcards
What is the arterial supply of the bladder?
branches of the internal iliac:
- superior vesical artery
- vaginal artery
- minor branches gluteal and obturator arteries
What is the venous drainage of the bladder?
- vesicle venous plexus -> internal iliac
What is the nerve supply of the bladder?
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
Lymphatic drainage of the bladder
internal iliac nodes
external iliac nodes
common iliac nodes
bladder wall structure
mucosa (transitional epithelium and lamina propria), submucosa, detrusor and adventitia
The plane of the pelvic inlet is at what angle to the horizontal?
60 degrees
Which vein does the left ovary drain into?
L ovarian vein travels through the suspensory ligament of the ovary and drains into the left renal vein
Which vein does the right ovary drain into?
R ovarian vein travels through the suspensory ligament of the ovary and generally joins the IVC
Venous drainage of the uterus
uterine vein -> internal iliac vein
Venous drainage of the vagina
Vaginal venous plexus -> internal iliac
Fallopian tubes venous drainage
Uterine and ovarian veins
cervix venous drainage
uterine veins -> internal iliac
small bowel venous drainage
hepatic portal vein & superior mesenteric vein -> liver sinusoid
large bowel venous drainage
inferior and superior mesenteric veins -> splenic vein and hepatic portal vein
kidney venous drainage
renal vein -> ÍVC
ureter venous drainage
renal veins and superior and inferior vesical veins -> IVC
venous drainage of spleen
splenic vein -> hepatic portal vein
liver venous drainage
hepatic vein and hepatic portal vein -> liver sinusoid
pancreas venous drainage
pancreaticoduodenal veins, pancreatic veins -> splenic vein
Ascending colon arterial supply
Superior mesenteric artery (right colic artery = main branch)
Transverse colon proximal 2/3 arterial supply
SMA (middle colic)
Transverse colon distal 1/3 arterial supply
Inferior mesenteric artery (ascending branch left colic)
Descending colon arterial supply
IMA (left colic)
sigmoid colon arterial supply
IMA (sigmoid arteries)
rectum upper 2/3 arterial supply
IMA (superior rectal)
rectum lower 1/3 arterial supply
Internal iliac (middle rectal)
Anal canal arterial supply
Internal pudendal (inferior rectal)
Where does the ovarian artery arise from?
Abdominal aorta
(May anastomose with the uterine artery)
Pudendal nerve origins
S2, S3, S4
Pudendal nerve terminal branches
Inferior rectal nerves
Perineal nerve
Dorsal nerve of the clitoris
Pudendal nerve muscles innervated
bulbospongiosus
ichiocavernosus
levator ani muscle group (iliococcygeus, pubococcygeus, puborectalis)
external anal sphincter
female external urethral sphincter
Innervation of the internal and external anal sphincters
Internal = innervated by pelvic splanchnic nerves (S4)
- sympathetic contraction,
- parasympathetic relaxation.
External = pudendal nerve (inferior rectal branch) & perineal branch of S4
Obturator nerve entrapment
Compression between head of the fetus and bony structures of the pelvis
- sensory loss = upper medal thigh
- motor loss = weakness leg adduction
Common peroneal nerve entrapment
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
Lateral femoral cutaneous nerve entrapment
Occurs with advancing gestation
= sensory loss only - lateral thigh
Femoral nerve entrapment
from pressure from a fetus in a difficult birth
- sensory loss = anterior thigh and knee
- motos loss = quadriceps (SLR) weakness, loss of knee jerk
Testicular cell types
- Sertoli cells = secrete inhibin. Form blood-testis barrier. Have FSH receptors.
- Leydig cells = secrete testosterone. Have LH receptors.
Arterial supply of the testes
Testicular arteries
Cremasteric artery
Artery to vas deferens
Venous drainage of the testes
Testicular vein
Pampiniform plexus
Testicular lymphatic drainage
lumbar and para-aortic nodes
Testicular innervation
Spermatic plexus
T10 spinal segment
Labia Majora innervation
- 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.
1st degree tear
Laceration limited to superficial perineal skin, vaginal mucosa and frenulum of labia minora
2nd degree tear
Extends to perineal muscle and fascia but spares anal sphincter
3rd degree tear - as for 2nd degree, but extends to involve external anal sphincter
3A - partial tear anal sphincter < 50% thickness
3B - partial tear anal sphincter >50% thickness
3C - internal sphincter is torn
4th degree tear
As for 3rd degree, plus rectal mucosa is torn
Pudendal nerve - roots and course
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.
Contents of the greater sciatic foramen
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
Average diameters within the pelvic inlet
Anteroposterior - sacrum to pubic symphysis = 11cm
Oblique - SIJ to iliopectineal eminence = 12cm
Transverse - widest point on the iliopectineal lines = 13cm
Contents of the femoral triangle
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