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Reproduction/Sexual Health > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Female repro structures found in pelvic cavity

A

Ovaries
Uterine tubes
Uterus
Superior part of vagina

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2
Q

Female repro structures found in perineum

A

Inferior part of vagina
Perineal muscles
Bartholin’s glands
Clitoris
Labia

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3
Q

Muscle making up most of pelvic floor

A

Levator ani

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4
Q

Where is parietal peritoneum in females?

A
  • floor of peritoneal cavity
  • roof over pelvic organs
  • covers superior aspect of organs
  • forms pouches (vesico-uterine, rector-uterine/Pouch of Douglas)
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5
Q

Where does fluid collect in an unright female abdomen?

A

Pouch of Douglas
- recto-uterine
- collections of pus/blood
- can drain through caldocentesis

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6
Q

Describe the broad ligament

A

Double layer of peritoneum
(formed by peritoneum draping up and back over uterine tubes)
Extends from uterus to lateral pelvis
Helps maintain uterus in correct midline position

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7
Q

Describe round ligament

A

Embryological remnant
Attaches anteriorly to lateral uterus
Passes through deep inguinal ring and attaches to superficial tissue of female perineum (labia)
Pain in preg as uterus grows

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8
Q

3 layers of uterus

A

perimetrium
myometrium (contracts during preg)
endometrium (thickens during menstrual cycle)

  • implantation of zygote in body of uterus
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9
Q

Position of uterus

A

Anteverted
- cervix tipped anteriorly relative to the axis of the vagina (vagina goes posterior and cervix goes forward)

Anteflexed
- uterus tipped anteriorly relative to the axis of the cervix (uterus sits on top of bladder)

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10
Q

Normal variations of uterine position

A

Retroverted
- cervix tipped posteriorly relative to the axis of the vagina

Retroflexed
- uterus tipped posteriorly relative to the axis of the cervix

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11
Q

3 supports of uterus

A

number of strong ligaments (e.g. uterosacral ligaments)

endopelvic fascia

muscles of the pelvic floor (e.g. levator ani)

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12
Q

Travel of ovum during ovulation

A

Ovary -> fimbrae of tube -> infundibulum -> ampulla (fertilisation) -> isthsmus -> uterus

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13
Q

WHat do you see in hysterosalpingogram (HSG)?

A

Radiopaque dye spilling out of the end of the uterine tube and into the peritoneal cavity
- shows tubes are open at the ends

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14
Q

Describe the ovaries

A

Almond sized and shaped, located laterally in the pelvic cavity (ovarian fossa)
Develop on the posterior abdominal wall
Secrete oestrogen and progesterone

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15
Q

Which ant pituitary hormones act on the ovaries?

A

FSH and LH

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16
Q

Describe the structure of vagina

A

Muscular tube whose walls are normally in contact
- except superiorly where the cervix holds them apart forming a fornix (around the cervix).
- fornix = anterior, posterior, 2x lateral

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17
Q

What is sampled in cervical screening?

A

Squamo columnar junction (transformation zone)

  • brush is inserted into the external cervical os with firm pressure and rotated
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18
Q

What structures are palpated on vaginal digital exam?

A

Uterus position - bimanual palpation
Adnexae, masses/tenderness - using fornices
Ischial spines - laterally, 4 and 8 oclock

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19
Q

Describe levator ani

A

Skeletal muscle - voluntary, normally tonically contracted
Majority of pelvic diaphragm
Nerve to levator ani (S3, 4, 5), dual supply

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20
Q

Describe shape of perineum

A

shallow space between pelvic diaphragm and the skin

diamond shaped

openings in pelvic floor
- passage of distal parts of alimentary, renal and reproductive tracts from pelvis to perineum

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21
Q

Describe the perineal body

A

bundle of collagenous and elastic tissue into which the perineal muscles attach

VERY important to pelvic floor strength

can be disrupted during labour

located just deep to skin

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22
Q

What is a Bartholin/greater vestibular gland?

A

Secrete lubricating mucus to opening of vagina
Enlarged gland due to cyst/infection

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23
Q

Structures in the vestibule

A

EXt urethral orifice
Vaginal orifice

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24
Q

Anatomy of breast

A

From ribs 2-6
- lateral border of sternum to mid-axillary line
- lies on deep fascia covering pec major/serratus anterior
- firmly attach to skin via suspensory ligaments

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25
Q

Where is retromammary space?

A

Between fascia and breast
- means breast tissue should be able to move freely
- if immobile/fixed, means tissue has extended into pec major (clinically worrying)

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26
Q

Where does lymph from breast drain?

A

ipsilateral axillary lymph nodes
- then to the supraclavicular nodes

inner quadrant lymph can spread to contralateral parasternals

lower quadrant lymph can drain to abdo lymph nodes

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27
Q

Describe clearance of axillary nodes

A

Level I – inferior and lateral to pectoralis minor

Level II – deep to pectoralis minor

Level III – superior and medial to pectoralis minor

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28
Q

Blood supply to breast

A

Axillary artery
Internal thoracic (internal mammary)

Venous drainage mimics above (mostly axillary)

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29
Q

Phases of ovarian cycle

A

Follicular phase
Ovulation
Luteal phase

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30
Q

Phases of uterine cycle

A

Menstrual phase
Proliferative phase
Secretory phase

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31
Q

Function of primitive streak in embryo

A

Develops the body axis
Found on the caudal end
- embryo knows which way is up and down

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32
Q

What is gasrtulation?

A

Change form a bilaminar disc to trilaminar disc with a mesoderm layer
(two to three layers)
Cells invaginate int primitive streak and spread back out to form 3rd layer

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33
Q

Origin of repro system and genitals

A

Intermediate mesoderm

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34
Q

How does the indifferent gonad develop?

A
  1. Migration of PGCs from yolk sac to intermediate mesoderm
  2. Coelomic epithelium proliferates and thickens to form genital ridges.
  3. This prolif epi forms somatic supports which envelop PGCs
  4. This forms primitive sex cords (indifferent)
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35
Q

Structures forming genital ducts in embryo’s ambisexual phase

A

Embryo has both types

Mesonephric (Wollfian) duct
= male
Paramesonephric (Mullerian) duct
= female

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36
Q

Female development from germ cells in absence of SRY

A

Germ cells differentiate into oogonia and then into primary oocytes

Somatic support cells differentiate into granulosa cells and surround the primary oocytes

This forms primordial follicles in the ovary

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37
Q

WHy are thecal cells important in female development?

A

They help to produce part of oestrogen which stimulates formation of the female external genitalia and development of paramesonephric ducts.

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38
Q

What structures does paramesonephric tube give rise to?

A

Uterine tubes
Uterus
Superior vagina

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39
Q

3 parts of paramesonephric duct

A

CRANIAL portion which opens up into the coelomic cavity

HORIZONTAL portion which crosses the mesonephric duct

CAUDAL portion which fuses with the paramesonephric duct on the opposite side

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40
Q

Male development from germ cells in presence of SRY

A

Somatic support cells develop into Sertoli cells

Primary sex cords form testis/medullary cords, which engulf the PGC’s

Rete testis connect the mesonephric tubules to the testis cords

Tthickened layer of connective tissue forms the tunica albuginea.

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41
Q

How are Leydig cells significant in terms of male development?

A

They are stimulated to form by Sertoli cells and secrete testosterone.
This induces formation of epididymis, vas deferens, seminal vesicles
Dihydrotestosterone then induces male spec genitalia and prostate

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42
Q

Describe persistent Mullerian duct syndrome

A

Mullerian (paramesonephric) ducts fail to regress

Present with:
- Uterus, vagina and uterine tubes
- Testes in ovarian location
- Male external genitalia

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43
Q

Function of gubernaculum in testes deveopment

A

Pulls gonads down from T10 caudally down in scrotum
Failure = cryptorchidism

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44
Q

3 male accessory glands

A

develop near the junction of mesonephric duct and urethra, during week 10.
- prostate gland
- bulbourethral gland
- seminal vesicle

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45
Q

Development of male external genitalia

A

Spongy urethra forms by proximal to distal ‘zipping’ of urethral groove

Ectodermal ingrowth at tip of the glans penis, which meets spongy urethra

  • Prepuce (foreskin) is formed by circular ingrowth of ectoderm around the periphery of the glans
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46
Q

Describe pres of hypospadias

A
  • External urethral opening lies in an abnormal position along the ventral aspect of the penis
  • Occurs with varying degrees of severity.
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47
Q

Where does inguinal ligament run?

A

Between ASIS and pubic tubercle

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48
Q

Where do 3 hamstrings attach?

A

Ischial tuberosity

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49
Q

Describe tendinous arch of levator ani

A

Thickened fascia of levator ani

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50
Q

When does externa iliac artery become femoral?

A

When it passes under the inguinal ligament

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51
Q

Where do gonadal arteries originate?

A

Abdo aorta at L2 ish
(this is where ovaries/testes originate)

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52
Q

Two divisions of internal iliac artery

A

Anterior = visceral
Posterior = parietal (mainly body wall)

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53
Q

Medial umbilical ligament is remnant of

A

Umbilical cord
(obliterates away as redundant)

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54
Q

Where does anterior scrotal artery originate from?

A

External iliac artery

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55
Q

What is in place of inferior vesicle arteries in females?

A

Superior vesicle arteries
Vaginal arteries, also sends branches to bladder

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56
Q

Where do ovarian and uterine artery anastomose?

A

Ovarian and tubal branches of ovarian artery come down the uteris and anastomose with uterine artery at neck of uterus/cervix

Uterine also anastomoses with vaginal artery lateral to ureter

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57
Q

Anatomical relationship between ureter and uterine artery

A

Water passes under the bridge
- ureter under uterine artery

Tell the diff because ureter wiggles when touched

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58
Q

Where does venous blood in the pelvis drain to?

A

Mainly to iliac vein
- some via superior rectal to hepatic portal
- some via lateral sacral veins into internal vertebral venous plexus (aka epidural venous plexus)

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59
Q

How are the epidural venous plexuses significant in terms of pelvic mass?

A

They are valveless and allow positional travel of blood, no regulation

Can follow metastatic pathway into epidural space etc

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60
Q

Which nerve in pelvic lateral wall doesn’t originate from sacral plexus?

A

Obturator nerve

61
Q

S2, 3, 4

A

Keeps the poo off the floor

62
Q

Where does lymph from superior pelvic viscera drain to first?

A

external iliac nodes
THEN common iliac, aortic, thoracic duct, venous system

63
Q

Where does lymph from inferior pelvic viscera and deep perineum drain to first?

A

internal iliac nodes
THEN common iliac, aortic, thoracic duct, venous system

64
Q

Where does lymph from superifical perineum drain to first?

A

superficial inguinal nodes

65
Q

Where does gonadal lymph drain to?

A

Para-aortic/lumbar/caval
(because this is where they originated)

66
Q

3 bones fusing to form hip bone

A

ilium

ischium

pubis

67
Q

Muscle that sits in iliac fossa

A

Iliacus

68
Q

Attachment of inguinal ligament

A

ASIS to pubic tubercle

69
Q

Muscles attaching to ischial tuberosity

A

3 true hamstrings

70
Q

Borders of pelvic inlet

A

sacral promontory
ilium
superior pubic ramus
pubic symphysis

71
Q

Borders of pelvic outlet

A

pubic symphysis
ischiopubic ramus
ischial tuberosities
sacrotuberous ligaments
coccyx

72
Q

Where are ischial spines palpable?

A

On vaginal examination: approx. 4 and 8 o’clock positions

73
Q

Clin significance of pubic symphysis in obstetrics

A

Constant point from which to measure fundal height

74
Q

Type of joint pubic symphysis

A

Secondary cartilaginous
- not much movement
- can loosen during pregnancy, may cause pain
- can lead to PS dysfunction, sort of dislocated

75
Q

Attachments of
sacrotuberous ligament, sacrospinous ligament

A

sacspin - sacrum and ischial spine
sactub - sacrum and ischial tuberosity

76
Q

Function of pelvic ligaments

A

Protection against sudden weight transfer
- these ligaments relax later in pregnancy

77
Q

Foraminae of pelvic formed by ligaments

A

Greater sciatic foramen
Lesser sciatic foramen

  • formed by attachments of ligaments to sciatic notches
78
Q

Name for deep fascia of obturator internus

A

Tendinous arch
- where levator ani attaches

79
Q

Key differences between male and female pelvis

A

the AP and transverse diameters of the female pelvis are larger than the male, both at the pelvic inlet and outlet

the subpubic angle (and pubic arch) in the female is wider than the male

the pelvic cavity is more shallow in the female

80
Q

Define moulding

A

the movement of one bone over another to allow the foetal head to pass through the pelvis during labour

81
Q

When do fontanelles close?

A

Ant - 18-24 months
Post - 12-18 months

82
Q

What is the vertex of foetal skull?

A

area outlined by the anterior and posterior fontanelles and the parietal eminences

83
Q

Diameters of foetal skull

A

occipitofrontal diameter is longer than the biparietal diameter (i.e. the foetal head is longer than it is wide)

84
Q

What is the station during childbirth?

A

The distance of the foetal head from the ischial spines is referred to as the station.

Negative number means the head is superior to the spines
Positive number means the head is inferior to the spines

85
Q

Position of baby during delivery

A

Baby flexed with chin on chest
Leave pelvic cavity in OA position
During delivery baby’s head should be in extension

86
Q

Foetal head position in childbirth

A

at the pelvic inlet, the foetal head should be transverse

as it descends through the pelvic cavity, the foetal head should rotate and it should be flexed

at the pelvic outlet, the foetal head should ideally lie occipitoanterior (OA) and extension of the head on the neck should occur

further rotation after baby’s head is delivered to allow delivery of shoulders

87
Q

Type of nerve supplying pelvis

A

Body cavity
sympathetic, parasympathetic and visceral afferent

88
Q

Type of nerve supplying perineum

A

Body wall
somatic motor and somatic sensory

89
Q

Superior part of pelvic organ/if painful pelvic organ is touching peritoneum, visceral afferents run alongside…

A

Sympathetic fibres
- enter spinal cord at T11-L2
- pain felt as suprapubic
- e.g. uterine tubes, uterus, ovaries

90
Q

Inferior part of pelvic organ/if painful pelvic organ is not touching peritoneum, visceral afferents run alongside…

A

Parasympathetic fibres
- enter spinal cord at S2, 3, 4
- pain perceived in the dermatome, perineum
- e.g. cervix, sup vagina

91
Q

If structure crosses pelvis to perineum and is above levator ani, visceral afferents are carried with…

A

parasympathetic fibres
- spinal cord levels S2, S3 and S4

92
Q

If structure crosses pelvis to perineum and is below levator ani, visceral afferents are carried with…

A

somatic sensory (pudendal nerve)
- spinal cord levels S2, S3 and S4
- localised pain within perineum

93
Q

How do visceral afferents get to their correct spinal level from pelvis/peritoneum?

A

Mesh and travel with hypogastric plexuses

94
Q

Easy version of pelvic/perineal innervation

A

Perineum - pudendal, S2,3,4
Superior - touching peritoneum, T11-L2
Inferior - touching peritoneum, S2,3,4

95
Q

Anaesthetic injected into what region in spinal/epidural block?

A

L3-4 (sometimes up to L5)
- cauda equina L2, dural sac continues to S2
- lie pt on side and drape over pillow

96
Q

How to find L3-L4 space for spinal anaesthetic?

A

Find intercrystal plane (line between most superior points on iliac crests) and vertebrae superior should be L4
Space above L4 vertebrae is where anaesthetic should be injected

97
Q

WHat makes the pop sound during an epidural?

A

Needle piercing ligamentum flavum before it reaches epidural space

98
Q

Why is epidural slower acting than spinal?

A

Anaesthetic has to find its way through fat to anaesthetise spinal cord

Spinal goes directly into CSF and is very close to cord and rootlets

99
Q

Why is it important spinal anaesthetic is balanced?

A

Blocks sympathetic fibres of all arterioles and organs in area
- causes vasodilation
- skin looks flushed and warm
- reduced sweating
RISK OF HYPOTENSION

100
Q

Route of pudendal nerve

A

Exits pelvis via greater sciatic foramen

Passes posterior to sacrospinous ligament

Re-enters pelvis/perineum via lesser sciatic foramen

Travels in pudendal canal (alcock’s)

Branches to supply structures of the perineum

101
Q

How is pudendal nerve block given?

A

Palpate ischial spine with vaginal examination at 4 and 8 oclock
Inject anaesthetic from skin to sacspin ligament

At ninewells, they put in sheathed needle with hand and then unsheath and inject to nerve from within

102
Q

Degrees of perineal tears

A

1st degree: skin
2nd degree: skin and perineal muscle
3rd degree: nvolved anal sphincter
4th degree: through anal sphincter and bowel mucosa

103
Q

Incision made in episiotomy

A

Posterolateral (mediolateral) incision (down and out)
- incises fatty space
- reduces risk of tearing to anus
- easier to stitch up

104
Q

Attachments of external oblique

A

Attach between lower ribs and iliac crest, pubic tubercle and linea alba
Fibres run in same direction as external intercostals

105
Q

Attachments of internal obliques

A

Attach between lower ribs, thoracolumbar fascia, iliac crest and linea alba

Fibres run in same direction as internal
intercostals

106
Q

Attachments of transversus abdominus

A

Attach between lower ribs, thoracolumbar fascia, iliac crest and linea alba

107
Q

What is the linea alba?

A

Formed by the interweaving of the muscle aponeuroses

Runs from the xiphoid process to the pubic symphysis

(the vertical line in 6 pack)

108
Q

What are tendinous intersections of rectus abdominus?

A

divide each rectus abdominis

3 or 4 smaller muscles

(horizontal lines in 6 pack)

109
Q

What is the significance of the arcuate line?

A

Superior
- aponeuroses completely enclose rectus abdominus
- results in ant and post rectus sheath

Inferior
- aponeuroses only cover anterior rectus abdominus
- results in anterior rectus sheath

110
Q

Clin significance of rectus sheath

A

When undertaking a suprapubic incision i.e. LSCS, rectus sheath will be incised anteriorly

111
Q

Where is transversalis fascia found?

A

Between extraperitonal fat and transversus abdominus

112
Q

Nerve supply to anterolateral abdominal wall

A

enter from lateral direction

7th-11th intercostal nerves
become thoracoabdominal nerves

subcostal (T12)

iliohypogastric (L1)

ilioinguinal (L1)

113
Q

Blood supply to anterior abdominal wall

A

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

inferior epigastric arteries
- branch of the external iliac artery
- emerges at inferior aspect of abdominal wall
- just medial to inguinal ring

114
Q

Blood supply to lateral abdominal wall

A

intercostal and subcostal arteries
- continuations of posterior intercostal arteries
- emerge at lateral aspect

115
Q

How should you cut through muscle?

A

Incise in same direction as muscle

116
Q

How is the incision made in LSCS?

A

Rectus muscles not cut, they are separated form each other in a lateral direction, moves them closer to their nerve supply

117
Q

Layers incised when opening abdo for CS

A

Skin and fascia
(anterior) Rectus sheath
Rectus abdominis (separated not cut)
Fascia and peritoneum
Retract bladder
Uterine wall
Amniotic sac

118
Q

Layers stitched closed in CS

A

Uterine wall with visceral peritoneum**
Rectus sheath
Skin

119
Q

Layers incised and stitched in laparotomy

A

Layers when opening:
- Skin and fascia
- Linea alba
- Peritoneum

Layers to stitch closed:
- Peritoneum & Linea alba
- Fascia Skin

120
Q

Risk of midline incision

A

Relatively bloodless incision
- not great blood supply to aid healing
- increases the chance of wound complications e.g. dehiscence, incisional hernia

121
Q

Which artery do you need to watch out for with a lateral port in laparoscopy?

A

Inferior epigastric artery
- ensure you stay lateral

122
Q

Route of inferior epigastric artery

A

branch of the external iliac artery

emerges just medial to the deep inguinal ring

then passes in a superomedial direction posterior to the rectus abdominis

123
Q

Where is deep inguinal ring?

A

Between ASIS and pubic tubercle

124
Q

How to differentiate between ureter and uterine artery in hysterectomy etc?

A
  • the ureter passes inferior to the artery (“water
    under the bridge”)
  • the ureter will often “vermiculate” when touched
125
Q

Structure of secretory tissue of breast

A

15-25 lobes
- tubulo acinar gland, drains to nipple
Fibrous tissue adjacent to lobes
Adipose surrounds fibrous tissue

126
Q

Anatomical position of breast

A

2nd/3rd rib to 6th rib
Sternal edge to midaxillary line

127
Q

Describe structures of mammary bed

A

SUP
Deep pectoral fascia, lies on pec major and serratus anterior

INF
External oblique and aponeurosis

128
Q

Function of submammary space

A

Allows degree of breast movement on deep pectoral fascia

129
Q

Anatomical features of nipple

A

4th IC space in nulliparous women
15-20 lactiferous ducts
Circular/longitudinal smooth muscle

130
Q

Define tubercles of Montogomery

A

Sebaceous glands on outer margin of areola
Enlarge in pregnancy and lactation

131
Q

Function of 3 tissue types of breast

A

Glandular tissue: Tubulo-alveolar type and arranged in lobes

Fibrous tissue: Supports lobes and forms numerous septa.

Interlobar fatty tissue: makes the organ rounded in contour

132
Q

Drainage of glandular tissue of breast

A

15-20 pyradmidal lobes
-> lactiferous duct
-> dilates to form lactiferous sinus
-> segmental duct system
-> terminal ducts
-> pouches out like bunch of grape (acinar)

133
Q

Describe suspensory ligaments of Cooper

A

Fibrous structures that extend from dermis of skin to deep pec fascia overlying ant chest wall

Most pronounced in upper breast

Support breast tissue

134
Q

Describe function of TDLU

A

basic functional secretory unit of the breast

135
Q

Cells lining acini of sec lobule

A

secretory epithelial cells
- columnar and cuboidal
surrounded by myoepithelial cells
- contractile, surrounded by BL

136
Q

Outer layer of nipple

A

Keratinised stratified squamous epithelium
(skin hahahha)

137
Q

Mammary gland changes in pregnancy

A

1st trim
- elongation/branching of smalller ducts
- prolif of epi cells of glands and MEps

2nd trim
- continues to develop/differentiates secretroy alveoli
- plasma/lymphocytes infiltrate connective tissue

3rd trim
- alveoli mature
- development of extensive roughER

Adipose/connective tissue decr

138
Q

Changes to mammary gland in luteal phase

A

Epithelial cells get taller
Duct lumen enlarge
Small vol of secretion in ducts

139
Q

Hormones responsible for prolif of secretrory tissue in breasts in pregnancy

A

Oestrogen and progesterone

140
Q

Antibodies in breast milk

A

IgA

141
Q

Types of secretion in breat milk

A

Apocrine
- lipid droplets with small vol of cytoplasm surrounded by membrane

Merocrine
- exocytosis
- protein packaged by Golgi and secreted via vesicles, merge with apical membrane to release contents

142
Q

Effecct of menopause on mammary gland

A

secretory cells of the TDLU’s degenerate leaving only ducts

fewer fibroblasts, reduced collagen in connective tissue

143
Q

Blood supply of breast

A

Lateral Mammary branches from Lateral Thoracic a.
Medial Mammary branches from Internal Thoracic a.

All from subclavian

144
Q

Venous drainage of breast

A

Medial and Lateral Mammary vein

(mostly medial)

145
Q

Lymphatic drainage of breat

A

75% to axillary nodes
Subareolar plexus
Parasternal (also opposite sides, may drain to abdo)

146
Q

Innervation of breast

A

Branches of IC nerves 4-6
- sensory and symp efferent

Nipple
- ant branch of lateral cutaneous branch of T4

147
Q

Describe Paget’s disease of breast

A

Pre-cancerous changes eating into duct and epidermis of nipple and areolar, nipple first then areola

148
Q
A

Reproduction/Sexual Health (9 decks)

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