Anatomy Flashcards
which parts of the female reproductive system lie within the pelvic cavity?
Ovaries
Uterine tubes
Uterus
Superior part of vagina
which parts of the female reproductive system lie within the perineum?
Inferior part of vagina
Perineal muscles
Bartholin’s glands
Clitoris
Labia
which part of the round ligament is contained within the broad ligament?
proximal
what are the 3 layers of the body of the uterus?
perimetrium
myometrium
endometrium
where does implantation of the zygote occur?
in the body of uterus
most common uterus position
Anteverted and anteflexed
what is a normal variation in the positioning of the uterus?
retroverted and retroflexed
what are the 3 levels of support that hold the uterus in place?
- number of strong ligaments (e.g. uterosacral ligaments)
- endopelvic fascia
- muscles of the pelvic floor (e.g. levator ani)
where does fertilisation occur?
in the ampulla
what is a “bilateral salpingo-oophrectomy”
removal of both uterine tubes and ovaries
what is a “unilateral salpingectomy”
removal of one of the uterine tubes
where do the ovaries develop/move to?
on the posterior abdominal wall and move onto the lateral wall of the pelvis
what hormones do the ovaries secrete
oestrogen and progesterone
what are the 4 parts of the fornix?
anterior
posterior
2x lateral
in cervical screening, what must be sampled?
squamo columnar junction (transformation zone)
what can be palpated on a vaginal digital exam?
- position of the uterus
- the adnexae (uterine tubes and ovaries, and any massess/tenderness affecting these structures)
- ischial spines
nerve supply to levator ani
“nerve to levator ani”
- S3,4,5 sacral plexus
perineal muscles innervation
pudendal nerve
what ribs does bed of breast extend from?
ribs 2-6
what space lies between fascia and breast?
retromammary space
what attaches breast firmly to skin?
suspensory ligaments
where does most lymph (>75%) from the breast drain to?
ipsilateral axillary lymph nodes and then to the supraclavicular nodes
where do the gonadal arteries (testicular/ovarian) branch off the abdominal aorta?
L2
is the inferior vesical artery present in both males and females
males only
where does the internal pudendal artery exit the pelvis
greater sciatic foramen
what does the vaginal artery supply?
mainly vagina, also bladder
what is uterine artery a branch of
internal iliac
what does the ovarian artery supply
ovaries, uterine tube, uterus
anastomoses in the female pelvis
- ovarian and uterine arteries
- uterine and vaginal arteries
where is the most common site of iatrogenic injury to the ureter?
lateral to cervix
what is the internal vertebral venous plexus also known as
epidural venous plexus
most of the lateral pelvic wall nerves come from the _____ plexus, apart from the _________ nerve which comes from the _____ plexus
sacral
obturator
lumbar
pelvic splanchnic nerves
motor innervation to viscera of the pelvis parasympathetic, S2,3,4
lymphatics of the pelvis - higher up in pelvis where does stuff generally drain to?
external iliac nodes —> common iliac
lymphatics of the pelvis - lower in pelvis/deep perineum structures where does stuff drain to generally
internal iliac —> common iliac
lymphatics of the pelvis - where do gonadal drain to
lumbar
transperitoneal spread
disease can penetrate through the peritoneal layer and disseminate into the peritoneal cavity
what does the bony pelvis consist of?
2 hip bones
sacrum
coccyx
which muscle fills the iliac fossa?
iliacus
what group of muscles attach to ischial tuberosity?
hamstrings
pelvic inlet is also known as?
pelvic brim
is vagina in pelvis or perineum?
superior part - pelvis
inferior part - perineum
visceral afferents carrying pain from superior aspect of pelvic organs (touching the peritoneum) run alongside _____ fibres and enter spinal cord between levels ____
sympathetic
T11-L2
visceral afferents carrying pain from inferior aspect of pelvic organs (NOT touching the peritoneum) run alongside _____ fibres and enter spinal cord between levels ____
parasympathetic
S2,3,4
what separates pelvis and perineum
levator ani muscle
what nerve does most stuff in perineum? what are the nerve routes?
pudendal
S2,3,4
what spinal level does dural sac end
S2
what spinal level is anaesthetic injected into in spinal and epidural anaesthetic?
L3-L4 (L5) region
spinal anaesthetic vs epidural anaesthetic
same except for spinal you go through 2 extra layers - dura and arachnoid
which is faster acting - epidural or spinal anaesthetic?
spinal (closer to spinal cord and rootlets etc)
where does pudendal nerve exit the pelvis
greater sciatic foramen
where does pudendal nerve re-enter the pelvis/perineum
lesser sciatic foramen
when is pudendal nerve block used (labour)
painful vaginal delivery
if about to use instruments e.g. forceps
or episiotomy
or repairing perineal tears/incisions post delivery
1st-4th degree tears
1st degree - skin only
2nd degree - skin and perineal muscles
3rd degree - involves external anal sphincter
4th - goes further into the lining of your anus or bowel.
what direction is episiotomy incision made
posterolateral (mediolateral)
where do external obliques attach
between lower ribs and iliac crest, pubic tubercle and linea alba
which attach to thoracolumbar fascia - external or internal obliques?
internal
what does linea alba mean
white line
what is the rectus sheath
the covering lying over the rectus abdominus muscles
do you have a posterior rectus sheath lower down
nope, only have anterior
what is the transversalis fascia layer between?
transversus abdominis and extra peritoneal fat
nerve supply to anterolateral abdominal wall - what direction do they enter from?
lateral direction
what do the 7th-11th intercostal nerves become?
thoracoabdominal nerves
blood supply to anterolateral abdominal wall
anterior abdominal wall:
- superior epigastric arteries
- inferior epigastric arteries
lateral abdominal wall:
- intercostal and subcostal arteries
in a first pregnancy, when does the uterus come out of the pelvis (and can palpate)
12 weeks
fundal height at 20 weeks
umbilicus
fundal height at 36 weeks
xyphoid process
how is fundal height measured
pubic symphysis up to top of fundus?
are the rectus muscles cut in a LSCS
nope, they are just separated from each other is a lateral direction
LSCS layers when opening
- skin and fascia
- (anterior) rectus sheath
- rectus abdominis (separate not cutting)
- fascia and peritoneum
- retract bladder (bladder might be getting in the way)
- uterine wall
- amniotic sac
Laparotomy layers when opening
- skin and fascia
- linea alba
- peritoneum
Laparotomy layers to stitch closed
- peritoneum & linea alba
- fascia
- skin
laparoscopy - If a lateral port is required, care must be taken to avoid the ______ __________ ________
inferior epigastric artery
inferior epigastric artery landmarks
- emerges just medial to the deep inguinal ring
- then passes in a superomedial direction posterior to the rectus abdominis
what is the inferior epigastric artery a branch of?
external iliac artery
what are the 3 layers of the pelvic floor
- pelvic diaphragm
- muscles of perineal pouches
- perineal membrane
what is the deepest layer of the pelvic floor
pelvic diaphragm
levator ani forms most of the pelvic _________
diaphragm
what 3 muscles make up levator ani?
puborectalis
pubococcygeus
iliococcygeus
levator ani innervation
pudendal nerve and nerve to levator ani
bulbourethral glands (aka Cowper’s glands) function
produces a pre-ejaculate that cleanses and lubricates the urethra prior to the arrival of the semen.
4th degree prolapse
completely outside vagina
treatment options for uterine prolapse
- sacrospinous fixation
- incontinence surgery (controversial now because of the mesh thing)
