Anatomy Flashcards
What are the branches of the internal iliac?
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Iliolumbar
Lateral Sacral
Gluteal (Superior and Inferior)
Pudendal
Inferior Vesical
Middle Rectal
Vaginal
Obturator
Uterine and Umbilical
What is the most common artery injured during Gynaecology laparoscopy?
Inferior Epigastric
The name of an anastamosis between the obturator and external iliac or inferior epigastric arteries or veins situated behind the superior pubic ramus, can be injured during pelvic lymphadenopathy is…
Corona Mortis
What vessel is most likely to be injured during a sacrospinous fixation?
Inferior Gluteal as it passes behind sacrospinous ligament
What artery is most likely to bleed in 3rd degree tear?
Inferior rectal (branch of internal pudendal)
What artery bleeds following transverse suprapubic skin incision?
Superficial epigastric
What structures are cut during an episiotomy?
Skin
Sub cut tissue
Superficial and deep transverse perineal
Bulbospongiosus, part of elevator ani
Fascia
Transverse perineal branch of pudendal artery
Posterior vaginal wall
What is the rate of complication with repeated verses needle entry?
Complication rates increase with the number of attempts of insertion of a Veress needle – up to 64% after three attempts
What is the rate of vascular injury in laparoscopy?
Vascular injury during laparoscopy is associated with significant
morbidity and up to 23% mortality.
Vascular injury complicates approximately 0.1–1.1% of all laparoscopies.
Major injury complicates 1 in 200 (0.5% of laparoscopies).
Which nerves are liable to injury if a transverse incision extends beyond the lateral inferior rectus muscle?
Lateral cutaneous branches of iliohypogastric (gluteal/hypogastric) and ilioinguinal (inner thigh and groin) nerves (T12-L1)
Course of nerves:
Lateral psoas
Along quadratus lumborum
Through external oblique aponeurosis/inguinal ring
3.7% injury following Pfannenstiel, also from TOTs
Chronic pain in 7% if entrapped
What is the most commonly reported ureteric injury?
Transection (61%)
70% are diagnosed postoperatively
Commonest sites of injury - lower third (50%) then middle third (30%) then upper third
- Lateral to the uterine vessels
- Area of ureterovesical junction close to the cardinal ligaments
- Base of infundibulopelvic ligament as ureters cross the pelvic brim at ovarian fossa
- At the level of the uterosacral ligament
What diameter of midline port do you need to close the rectus
sheath?
What diameter of lateral port do you need to close the rectus sheath?
> 10mm in midline
7mm laterally
Discuss similarities and differences of the anterior and posterior fontanelles
Anterior fontanelle (Bregma)
- Bound anteriorly by the two halves of the frontal bone
- Bound posteriorly by the two parietal bones
- Diamond shaped
- Has a membraneous base at term and remains clinically palpable until ~18 months of age
- Remains palpable even after moulding during labour and the surrounding bones will not overlap
Posterior fontanelle (Lambda)
- Bound anteriorly by the two parietal bones
- Bound posteriorly by the occipital bone
- Triangular in shape
- Has an ossified base at term and no longer palpable by the 12 months of age
- The surrounding bones overlap during moulding
What are the types of puerperal genital haematomas?
Vuval/Vulvovaginal
-Superficial to the anterior vulval tissues anterior to urogenital diaphragm
-Damage to branches of internal prudendal (posterior rectal, transverse perineal and posterior labial)
Vaginal
-Between pelvic diaphragm and cardinal ligaments
-Damage to descending uterine artery
-Will be palpable intra-vaginally
Supravaginal
-Damage to uterine artery in the broad ligament
-May only present with collapse
