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Reproduction & Sexual Health > Anatomy > Flashcards

Anatomy Flashcards

1
Q

What is the only true female reproductive organ?

A

Ovaries

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2
Q

What makes up the pelvic cavity?

A

Ovaries, uterine tube, uterus, superior part of the vagina

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3
Q

Name the contents of the perineum

A

Inferior part of the vagina, perineal muscles, Bartholin’s glands, clitoris, labia

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4
Q

What is the peritoneum?

A

Thin, transparent serous membrane that lines the abdominal cavity and wraps around organs - covers superior aspect of organs

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5
Q

Name the two peritoneal pouches in females

A

Vesico-uterine

Recto-uterine (Pouch of Douglas)

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6
Q

What is the clinical significance of the Pouch of Douglas?

A

Most inferior part of the peritoneal cavity can collect excess fluid

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7
Q

How is the pouch of Douglas drained?

A

Though the posterior fornix of the vagina

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8
Q

Describe the broad ligament

A

Double layer of peritoneum that extends between the uterus and the lateral walls of the pelvic floor - helps to maintain the uterus in the midline position

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9
Q

Describe the round ligament

A

Embryological remnant attaches to the lateral aspect of the uterus, passes through the deep inguinal ring to attach to the superficial tissue of the perineum

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10
Q

Name the three layers of the uterus

A
  • perimetrium
  • myometrium
  • endometrium
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11
Q

Where does implantation occur?

A

Body of the uterus

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12
Q

What is the common position of the uterus?

A

Anteverted and anteflexed

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13
Q

Describe the term anteverted and anteflexed

A

Cervix is tipped anteriorly relative to axis of the vagina

Uterus tipped anteriorly relative to axis of cervix

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14
Q

Name the common variation of uterus position

A

Retroverted and retroflexed

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15
Q

Describe the different parts of the uterine tubes

A

Isthmus, ampulla, infundibulum with fimbrae which open into the peritoneal cavity

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16
Q

What is the disadvantage of the uterine tubes opening into the peritoneal cavity?

A

Infection can enter here

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17
Q

How many fornix can be found in the vagina?

A

4
Anterior
Posterior
2 lateral

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18
Q

What two triangles can be separated by an imaginary line between the two ischial spines?

A

Urogenital

Anal

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19
Q

What is the function of the pelvic floor?

A

Provides support to pelvic organs and maintains continence

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20
Q

Name the two muscles of the pelvic diaphragm

A
  • levator ani

- coccygeus

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21
Q

What are the three parts of the levator ani?

A
  • puborectalis (pubic bone and anus)
  • pubococcygeus (pubic bone and coccyx)
  • iliococcygeus (ilium and coccyx)
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22
Q

Describe the perineal body

A

Collection of collagenous/elastic tissue into which the perineal muscles attach

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23
Q

Describe the action of levator ani

A

All tonically contracted most of the time, must relax to allow urination and defection

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24
Q

What nerve supplies the levator ani?

A

Pudendal nerve and nerve to levator ani

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25
Q

Which nerve innervates coccygeus?

A

Branches of S4 and S5

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26
Q

What two structures give additional support to the pelvic floor?

A

Endo-pelvic fascia

Pelvic ligaments

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27
Q

Name four pelvic ligaments

A
  • uterosacral
  • transverse cervical
  • lateral ligament of bladder
  • lateral rectal ligaments
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28
Q

Where can the deep perineal pouch be found?

A

Shallow compartment lies between the fascia covering the inferior pelvic diaphragm and the perineal membrane

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29
Q

Describe the contents of the deep perineal pouch

A

Part of urethra and vagina, bulbourethral gland in males, neuromuscular bundle (clitoris/penis), anterior extensions of ischioanal fat pads, muscles

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30
Q

Which muscles are found in the deep perineal pouch?

A

External urethral sphincter
Compressor urethrae
Deep transverse perineal muscle (males)
Band of smooth muscle (females)

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31
Q

Where is the perineal membrane?

A

Superficial to the deep perineal pouch

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32
Q

What is the perineal membrane made of and where does it attach?

A

Thin sheet of tough deep fascia.

Attaches laterally to the pubic arch and closes over the urogenital triangle

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33
Q

Where is the superficial perineal pouch?

A

Superficial to the perineal membrane

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34
Q

What does the superficial perineal pouch contain in women?

A

Clitoris and crura - covered by ischiocavernosus
Bulbs of vestibule - covered by bulbospongiosus
Bartholins glands, transverse perineal muscle branches of vessels and nerves

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35
Q

What does the superficial perineal pouch contain in men?

A

Bulb - corpus spongiosum (bulbospongiosus)
Crura - corpus cavernosum (ischiocavernosus)
Proximal spongy urethra, superficial transverse perineal muscle, pudendal nerves/vessels

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36
Q

Where does the breast extend to/from?

A

Ribs 2-6

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37
Q

What does the breast tissue sit on?

A

Deep fascia covering the pecs major and serratus anterior

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38
Q

Name the space found between the fascia and breast

A

Retromammary Space

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39
Q

How is the breast tissue attached to the skin?

A

Suspensory ligaments

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40
Q

Where does most lymph from the breast drain?

A

Ipsilateral axillary then supraclavicular nodes

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41
Q

Where can lymph from the inner quadrants of the breast drain?

A

Parasternal nodes

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42
Q

Where can lymph from the lower quadrants drain?

A

Abdominal nodes

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43
Q

What is the arterial supply to the breast?

A
  • anterior intercostal branches of the internal thoracic artery from the subclavian artery
  • branches of the axillary
  • posterior intercostal arteries
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44
Q

What is the venous drainage of the breast?

A

Axillary vein and internal thoracic vein

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45
Q

What is the tissue extending to the mid-axillary line called?

A

Tail of Spence

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46
Q

What bones make up the lateral pelvic wall?

A

Pubis, ischium and ilium

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47
Q

Name three ligaments found in the lateral pelvic wall

A

Sacrospinous
Sacrotuberous
Obturator Membrane

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48
Q

What does the obturator membrane fill?

A

The obturator foramen - NVB passes through the canal

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49
Q

What do the sacrospinous and sacrotuberous ligaments form?

A

Greater and lesser sciatic foramen

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50
Q

Name four muscles that are in the lateral pelvic wall

A

Levator ani
Obturator Internus
Piriformis
Coccygeus

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51
Q

Where does the levator ani attach?

A

Tendinous arch - band of thickened fascia from the obturator interns muscle

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52
Q

Where does the obturator internus tendon pass?

A

Between the superior and inferior gemellus

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53
Q

Describe the route of the piriformis muscle

A

Passes through the greater sciatic foramen and attaches to the greater trochanter of the femur

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54
Q

Why is the piriformis an important landmark?

A

Where the sciatic nerve emerges and the gluteal nerve divides

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55
Q

What is the major blood supply to the pelvis?

A

Internal iliac artery

56
Q

What are the two exceptions to the internal iliac blood supply?

A

Gonadal artery - arises at L2 from abdominal aorta

Superior rectal artery - continuation of the inferior mesenteric

57
Q

Describe the division of the internal iliac artery

A

Anterior - visceral

Posterior - parietal

58
Q

What remnant is found relating to foetus blood supply?

A

Medial umbilical ligament from the umbilical artery which connected the internal iliac to the placenta

59
Q

What branches arise from the posterior division of the internal iliac?

A

Gluteal arteries - inferior may come from the anterior division

60
Q

What branches arise from the anterior division of the internal iliac?

A

Obturator artery
Superior vesicle arteries - supplies the bladder
Uterine artery - gives off vaginal artery
Internal pudendal

61
Q

Which artery does the middle rectal artery arise from?

A

Internal pudendal

62
Q

What arteries arise from the vaginal artery?

A

Inferior vesicle

63
Q

Describe the two anastomoses in the pelvic blood supply

A

Uterine and ovarian

Uterine and vaginal

64
Q

What structure lies close to the uterine artery and can be damaged during a hysterectomy?

A

Ureter - water under the bridge

65
Q

Describe the differences between the right and left ureter

A

Right - lies more laterally and crosses external iliac

Left - lies more medially and crosses the common iliac

66
Q

What two arteries supply the perineum ?

A

Internal pudendal

External iliac

67
Q

What are the branches of the internal pudendal nerve in females?

A

Inferior rectal
Middle rectal
Dorsal artery of clitoris (where it terminates)
Perineal artery

68
Q

What is the branch of the external iliac artery in females?

A

Labial arteries

69
Q

In the male where do the inferior vesicle arteries arise?

A

Internal iliac artery

70
Q

What two branches arise from the inferior vesicle arteries?

A

Prostatic branch

Artery to vas deferens

71
Q

What are the branches of the internal pudendal nerve in males?

A

Perineal
Posterior scrotal
Deep artery
Dorsal artery of penis (termination)

72
Q

What branch of the external iliac artery supplies the perineum in males?

A

Anterior scrotal

73
Q

Name the three common venous drainage systems of the pelvis

A

Internal iliac vein to IVC
Superior rectal and into the portal-hepatic system
Lateral sacral and to the internal vertebral venous plexus

74
Q

Describe the route of the obturator nerve

A

Formed from lumbar plexus (L2,3,4) and passes through extraperitoneal fatty tissue to the obturator canal

75
Q

Describe the route of the pudendal nerve

A

S2,3,4 exits via the greater sciatic foramen posterior to the sacrospinous ligament and comes back into the perineum via the lesser sciatic foramen

76
Q

What spinal levels does the nerve to the levator ani arise?

A

S3,S4

77
Q

What are the pelvic sphlanic nerves?

A

Exit via the anterior rami of S2,3,4 carry parasypathetic innervation

78
Q

Name the lymph nodes that the pelvis drains to

A 
Lumbar/aortic 
Inferior mesenteric 
Common iliac 
External iliac 
Internal iliac 
Superficial inguinal 
Deep inguinal 
Sacral 
Pararectal
79
Q

Generally where does the superior pelvic viscera drain lymphatically?

A

External iliac nodes

80
Q

Generally where does the inferior pelvic viscera drain?

A

Internal iliac nodes

81
Q

Where does lymph from the superficial perineum drain?

A

Superficial inguinal nodes

82
Q

Where does lymph from the ovaries and testes drain?

A

Lumbar lymph nodes

83
Q

Describe transperitoneal spread

A

Usually peritoneal layer can act as a barrier to infection but eventually disease can penetrate and the disease can travel in fluid or on the layer itself

84
Q

State the functions of the bony pelvis

A 
Supports upper body 
Transference of weight
Attachment of muscles 
Attachment of external genitalia 
Protection of pelvic organs 
Passage of childbirth
85
Q

What makes up the bony pelvis?

A

Hip bones (ischium, ilium, pubis)
Sacrum
Coccyx

86
Q

Name the landmarks of the ilium

A

Iliac crest
ASIS
PSIS
Iliac fossa

87
Q

Name the landmarks of the ischium

A

Ischiopubic rams
Ischial spine
Ischial tuberosity

88
Q

Name the landmarks of the pubis

A

Ischiopubic ramus
Superior pubic ramus
Pubic tubercle
Pubic arch

89
Q

How do you palpate the ischial spines?

A

4 and 8 o’clock internally

90
Q

State the key differences between the male and female pelvis

A

AP and transverse diameter bigger in females
Subpubic angle wider in females
Pelvic cavity is more shallow in females
Greater sciatic notch is wider in females
Sacral promontory less pronounced in females
Female bones are thinner and males more robust

91
Q

What makes up the pelvic inlet?

A

Sacral promontory
Ilium
Superior pubic ramus
Pubic symphysis

92
Q

What makes up the pelvic outlet?

A 
Pubic symphysis 
Ischiopubic ramus 
Ishchial tuberosities 
Sacrotuberous ligaments 
Coccyx
93
Q

What are the key joints in the bony pelvis?

A 
Sacroiliac (synovial and syndymoses) 
Hip joint (synovial) 
Pubic symphysis (cartilaginous)
94
Q

Describe the pelvic movement during pregnancy

A

SI joint rotates anteriorly and inferiorly causing the sacrum and coccyx to rise but the ligaments prevent this from going too far

95
Q

What happens to the ligaments in late pregnancy?

A

Relax due to a hormone - relaxin

96
Q

What tends to happen to ring bones in trauma?

A

They fracture in more than one place or combined with joint dislocation

97
Q

Name the two fontanelles in foetus

A

Anterior - closes 18 months to 2 years

Posterior - closes 6 months to 1 year

98
Q

What happens to the foetal skull during childbirth?

A

Moulding - movement of one bone over another to allow the head to pass through the pelvis

99
Q

What is the foetal vertex?

A

Diamond - pariteal eminences and fontanelles

100
Q

Define station

A

Distance of foetal head from the ischial spines

  • negative if above
  • positive if below
101
Q

Describe the rotation of the baby during childbirth

A
  2. Head moves into
  3. Shoulders align with AP and baby faces thigh
102
Q

What type of nerves supply the pelvis?

A

Body cavity

  • sympathetic
  • parasympathetic
  • visceral afferent
103
Q

What type of nerves supply the perineum?

A

Body wall

  • somatic motor
  • somatic sensory
104
Q

Describe the innervation of superior aspect of pelvic organs/touching the peritoneum

A

Visceral afferents, run alongside the sympathetic fibres and enter the spinal cord between T11 and L2

105
Q

Describe the innervation of inferior pelvic organs

A

Visceral afferents run alongside parasympathetic and enter the spinal cord at S2,3,4

106
Q

What happens to structures that cross from pelvis to perineum?

A

Above levator ani - visceral afferents - S2,3,4

Below levator ani - somatic sensory - S2,3,4 (pudendal nerve)

107
Q

At what level does the spinal cord become the caudal equina?

A

L2

108
Q

When does the subarachnoid space end?

A

S2

109
Q

How can L4 spinous process be identified?

A

Intercrestal Line

110
Q

What does the needle to the epidural space pass?

A

Supraspinous ligament
Interspinous ligament
Ligamentum flavus
Epidural space - fat and veins

111
Q

What does the needle to the spinal space pass?

A 
Supraspinous ligament 
Interspinous ligament 
Ligamentum flavus 
Epidural Space 
Dura mater 
Arachnoid mater 
Subarachnoid space - filled with CSF
112
Q

What do the sympathetic nerves supply all of?

A

Arterioles

113
Q

What is the effect of blockage of the sympathetic nerves?

A

Vasodilation - reduced sweating, red, flushed, hypotension

114
Q

How is the pudendal nerve located?

A

Ischial spine, travels lateral and behind the sacrospinous ligament

115
Q

What is the purpose of episiotomy?

A

Posterolateral incision to prevent rectal damage and makes the tear towards the fat filled ischioanal fossa which is easier to repair

116
Q

Name four abdominal wall muscles

A

External oblique
Internal oblique
Transversus abdominus
Rectus abdominus

117
Q

Where does the external oblique attach and what direction does it run?

A 
Lower ribs (5-12), iliac crest, pubic tubercle, linea alba 
Inferomedial direction
118
Q

Where does the internal oblique attach and what direction does it run?

A

Attaches to lower ribs 10-12, thoracolumbar fascia, iliac crest, linea alba
Posteromedially

119
Q

Where does the transverses attach?

A

Lower ribs 7-12, thoracolumbar fascia, iliac crest, linea alba

120
Q

What fascia layers lie above and below transversus abdominus?

A

Neuromuscular plane - between muscle and IO

Transversalis fascia - internal lining deep to muscle

121
Q

Describe the rectus abdominus

A

Made up of 3/4 smaller muscles with tendinous intersection

Attaches to xiphoi, costal cartilage and pubic bones

122
Q

Describe the linea alba

A

Interweaving of aponeuroses, runs from xiphoïde process to pubic symphysis with lots of small vessels and nerves

123
Q

What is the rectus sheath?

A

Deep to the superficial fascia, combined aponeuroses of anterolateral abdominal muscles

124
Q

What nerves supply the abdominal wall muscles and where does this come from?

A

All enter from lateral direction.
7th-11th intercostal nerves to thoracoabdominal nerves
T12 - subcostal
L1 - iliohypogastric and ilioinguinal

125
Q

What blood vessels supply the anterior wall?

A

Superior epigastric arteries from internal thoracic - in the rectus sheath
Inferior epigastric arteries from external iliac

126
Q

What blood vessels supply the lateral wall?

A

Intercostal and subcostal arteries - continuation of posterior intercostal arteries

127
Q

What is usually done during a LSCS?

A

Rectus muscles are separated laterally towards nerve supply

128
Q

What layers will be passed during LSCS?

A

Fascia - sheath - rectus abdominus - peritoneum - retract bladder - uterine wall - amniotic sac

129
Q

What layers are stitched following LSCS?

A

Uterine wall, visceral peritoneum, rectus sheath, skin

130
Q

What layers are passed in a laparotomy?

A

Skin, fascia, linea alba, peritoneum

131
Q

Which layers requiring stitching post laparotomy?

A

Peritoneum, linea alba, fascia and skin

132
Q

What is the benefit/risk of a midline incision?

A

Benefit - relatively bloodless

Risk - wound complications

133
Q

Describe the route of the epigastric artery

A

Emerges medial to deep inguinal ring and passes superomedially posterior to rectus abdominus

134
Q

Where should lateral ports be placed?

A

Lateral to inferior epigastric artery

135
Q

Where is the deep inguinal ring?

A

Half way between ASIS and pubic tubercle

136
Q

Describe a vaginal hysterectomy

A

Local anaethetic around the cervix reflect bladder superiorly. Ligate arteries and ligaments and tubes. Remove uterus and cervix via vagina
Ligaments may be sutured to the vagina to prevent prolapse

Reproduction & Sexual Health (36 decks)

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