Anatomy Flashcards
In both genders, what are the roots of the external genitalia anchored to?
The bony margin of the anterior half of the pelvic outlet
The thick, fibrous perineal membrane within this area
Posterior border of the pelvic inlet?
The sacro-illiac body, projecting in as the sacral promontory
What ligaments help make up the true pelvis?
Sacrospinous and sacrotuberous ligaments
Where do the ligaments that help make up the true pelvis attach?
Sacrotuberous ligament - ischial tuberosity to sacrum
Sacrospinous ligament - ischeal spine to sacrum
What muscles help make up the true pelvis?
Obturator internus and piriformis
Where does the piriformis arise from
Anterior sacrum and sacro-illiac joint
Where does the piriformis insert?
Greater trochanter
Where does the piriformis pass through
Transversely through the greater sciatic foramen via the sciatic notch
Where does the obturator internus arise from?
The inferior margin of the superior pubic ramus and the pelvic surface of the obturator membrane
Where does the obturator internus insert?
Greater trochanter of the femur
Where does the obturator internus pass through
The inferior sciatic foramen
What structures create the pelvic outlet
Anterior - Pubic symphysis to ischeal tuberosity
Posterior - sacrotuberous ligament and coccyx
What are the pelvic floor muscles
Anterior - levitator ani
Posterior - coccygeas
What is the innervation for the pelvic floor
S2 - S4
Name the muscles that make up the levitator ani
Pubococcygeus, illiococcygeas, puborectalis
Illiococcygeas is attached to…
Ischeal spine and tendonous arch of levitator ani
What makes up the borders of the pelvic outlet
Coccyx, pubis symphysis, ischeal tuberosity
What does piriformis do
Lateral rotation of the femur
What nerve roots innervate piriformis
S1 & S2
What innervates obturator internus
Obturator nerve
What does obturator internus do
Lateral rotation of the femur
Where does the obturator nerve arise from
Anteriorly from L2,3,4
What passes through the urogenital hiatus
Urethra and vagina
What are the segments of the perineum
Anterior - the urogenital triangle
Posterior - the anal triangle
What does the bulb of the penis become
Corpus spongeosum
What do the crura extend to become on males
The corpus cavernosum
What are the erectile muscles
Females - ischeocarvenosus and bulbospongiosus
Males - same but the bulbospongiosus is fused in the midline
What are the margins of the anal triangle
Anterior - posterior margin of the perineal membrane
lateral - Ischeoanal fossa
Posterior - coccyx
Posterio-lateral - sacrotuberous ligament
What is the blood supply to the true pelvis
Internal iliac artery (from the common iliac artery)
What is the artery to the perineum?
The internal pudendal artery (arising from the internal iliac artery)
Where does the pudendal nerve arise from
S2, S3 and S4
Where does the pudendal nerve arise from
S2, S3 and S4
What does the pudendal nerve innervate
Sensory - external genetalia, skin around anus, anal canal and perenium
Motor - pelvic muscles, external urethral sphincter and external anal sphincter
How does the pudendal nerve and internal pudendal artery enter the perineum?
Exit the pelvis via the greater sciatic notch, inferior to the piriformis, pass over the sacrospinous ligament and below the sacrotuberous ligament and through the Ischeoanal fossae
Where does the pudendal nerve pass in relation to the sciatic nerve?
Posterior
Where does the pudendal nerve pass in relation to the sciatic nerve?
Posterior
What is the pudendal canal?
The fascia covering obturator internus and the Ischeoanal fossa.
It contains the pudendal nerve, and internal pudendal artery and veins
Where does the internal rectal artery arise from
The internal pudendal artery within the pudendal canal
What does the pudendal nerve split to form
Dorsal nerve of the clitoris/penis and the perineal nerve
Where does the dorsal nerve of the clitoris/penis pass?
Deep perineal pouch
Where does the perineal nerve pass after it exits the pudendal canal
The superficial perineal pouch
Where does the internal pudendal artery pass
Continues within the deep perineal pouch
Where does the perineal artery pass
Superficial perineal pouch
What does the internal pudendal artery supply
Erectile tissue, urethra and clitoris/penis
What does the posterior labial/scrotal nerve supply?
Sensory - Skin of Labia Majora/scrotum
What does the perineal artery supply?
Labia/scrotum, transverse perineal muscles and perineal body
Where is colles fascia?
Membranous layer of the superficial perineal fascia binding down the muscles at the root of the penis
What arteries branch from the posterior illiac artery
Iliolumbar, lateral sacral and gluteal (superior and inferior)
What arteries branch from the anterior illiac artery
Internal pudendal artery, inferior vesicle/vaginal artery, middle rectal artery, obturator artery, umbilical and uterine artery
To what lymph nodes do the ovaries and testes drain
Para-aortic lymph nodes
What is the arterial supply to the levitator ani muscle
Inferior gluteal artery
Where is the cremasteric fascia derived from?
Internal oblique
What is derived from the transversalis fascia
Internal spermatic fascia
Where is the external spermatic fascia derived from
External oblique
Where do the uterine arteries run
Cardinal ligaments at the base of the broad ligaments
Where does the ovarian artery arise from
Abdominal aorta
(At L2 just below the renal artery)
What is dartos fascia
Specialised connective tissue layer over shaft, scrotum and foreskin. The muscles of dartos proper within the scrotum are responsible for thermoregulation
What is the name for the deep fascia of the penis?
Bucks fascia
What runs through the suspensory ligament of the ovary
Ovarian artery, ovarian vein, ovarian nerve plexus
Describe the fallopian tube anatomy from most distal to the uterus
Fimbrae > infundibulum> ampulla > isthmus > uterus
What connects the uterine fundus to the labia majora
Round ligament
What does the uterosacral ligament connect
Cervix/posterior vaginal vault to the posterior pelvic wall
What ligament contains the uterine vessels
Cardinal ligaments
What are the two layers of the uterine endometrium
Deep stratum basalis
Superficial stratum functionalis
What are the three sections of the broad ligament
Mesosalpinx
Mesovarian
Mesometrium
Lymphatic drainage of the fallopian tube
Mixed - iliac, sacral, aortic
Cell types within the fallopian tubes
Ciliated columnar epithelium cells
Peg cells (non ciliated secretory cells)
Where do the ovarian arteries arise from
Aorta below the renal arteries (L2)
Where do ovarian veins drain into
Left -> left renal vein
Right -> inferior vena cava
Nerves of the ovary?
Ovarian and uterine plexus
Cells of the ectocervix
Stratified squamous non-keratinized epithelium
Cells of the endocervix
Mucus secreting simple columnar epithelium
Cervix blood supply
Uterine artery (from internal illiac artery)
Cervix blood drainage
Plexus in the broad ligament -> uterine veins -> internal iliac veins
Cervix lymphatic drainage
Internal Iliac!
external illiac, sacral, aortic, inguinal lymph nodes
What is the sit bone
Ischial tuberosity
What is the arterial supply to Levatator ani
Inferior gluteal artery
What innervates the internal anal sphincter
Pelvic splanchnic nerves (S2-S4, parasympathetic)
What drains to the internal iliac lymph nodes
Prostate, cervix, proximal vagina, corpus cavernosa, lower rectum
What drains into the para-aortic lymph nodes
Ovaries, testes, kidneys, uterus
What drains into the superficial inguinal lymph nodes
Distal vagina, distal anus, testes, vulva (skin areas!)
What drains to the external iliac lymph nodes
Body of uterus, cervix and superior bladder
What does ischiocavernosus do
Maintain penile erection.
Innervated by the deep perineal nerve
Layers of the penis superficial to deep
Skin, colles fascia, bucks fascia, tunica albuginea
Explain somatic sensory innervation of the vagina
Inferior 1/5 has somatic sensory innervation. Arises from deep perineal nerve from the pudendal nerve.
Where is the external urethral sphincter located in males?
Membranous urethra in the deep perineal pouch
Round ligament placement?
Horns of the uterus to labia majora
Ovarian ligament placement
Lateral surface of the uterus to ovaries
Broad ligament origin and insertion
Sides of uterus to walls and floor of pelvis
Where do suspensory ligaments originate and insert
Ovaries to walls of pelvis
Urethral lining cell type
Stratified squamous epithelium (transitional near the bladder)
What supplies somatic innervation to the external urethral sphincter
Pudendal nerve
What does the inferior hypogastric plexus supply
Uterine/vaginal plexus
Vesical plexus
Prostatic plexus
What nerve roots supply the anal reflex
S3 & S4
What supplies the external anal sphincter
Inferior rectal nerve (S2-S4)
What supplies the internal anal sphincter
Inferior hypogastric plexus
What innervates Levatator ani
Ramus of S4 and pudendal nerve (S2-S4)
What is the perineal flextire
Angle maintained by puborectalis, important for continence
What makes up the linea terminalis
Arcuate line, pectin pubis, pubic crest
Where is the sacral plexus in comparison to piriformis
Anterior
Motor function of pudendal nerve
Perineal skeleton muscles, external urethral and anal sphincters, levitator ani
Sensory function of pudendal nerve
Perineal skin, penis, clitoris
Energy source for spermatogenesis
ATP dephosphorylation (conversion of ATP to ADP and inorganic phosphate)
What hormone controls spermatogenesis
FSH (mainly)
Pain sensation in the cervix
Pelvic splanchnic nerves
At what spinal level does the aorta pass through the diaphragm
T12
Nerve roots for lower abdominal reflex
T7-T12
Nerve roots for cremasteric reflex
L1
What lies posterior to suspensory ligament
Ureter
What runs through the suspensory ligament
Ovarian artery and veins
Cardinal ligament contents
Uterine artery and vein
Cardinal ligament contents
Uterine artery and vein
What structures are at risk of the cervix is perforated
Uterine artery and vein
What is the mesovarium
Where the broad ligament attaches to the ovaries
Where does the round ligament pass
Through the deep inguinal ring to enter the inguinal canal
What ligament can cause pain in pregnancy
Round ligament
Where does the uterosacral ligament run
Uterus to sacrum
Where is the pubucervical fascia run
Cervix to pubic bone
What spinal level does the ovarian artery emerge
L1
Blood supply to cervix
Uterine artery from anterior division of internal illiac artery
Blood supply to upper third of vagina
Uterine artery
What arterial injury most likely to cause rectal sheath hematoma
Inferior epigastric artery
Lap trochar can injure which artery?
Aorta
What autonomic nerves control the bladder
the superior hypogastric plexus
What innervation does the ovary get?
Sympathetic and parasympathetic from the uterine and ovarian plexuses
How do nerves reach the ovary?
Via the suspensory ligament of the ovary
Innervation of upper vagina?
Parasympathetic and sympathetic innervation from hypogastric plexus.
NO somatic (pain) innervation
What artery is contained within the round ligament
Sampson’s artery (branch of inferior epigastric)
What ligaments on females are gubernaculum remnants?
Round and ovarian suspnsory
Anterior vulval nerve supply
Ilioinguinal nerve, genital branch of genitofemoral nerve
Posterior vulval nerve supply
Pudendal nerve (perineal nerve and labial nerve) and posterior cutaneous nerve of the thigh
Clitoral nerve supply
Cavernous nerves (parasympathetic), clitoral branch of the pudendal nerve
What nerve roots can a pfannenstiel incision damage
T12-L1
What nerve can be damaged in lithotomy
Lateral cutaneous nerve of the thigh (L2-L3)
Nerve roots of diaphragmatic shoulder tip pain from ectopic
C3- C5
Peritoneal pain transmitted by sympathetic nervous system what nerve roots
T10- L2 (umbilicus, suprapubic anterior thigh)
Irritation of cervix/vagina/bladder felt?
Parasympathetic nervous system S2-S4 buttocks and posterior thigh
Describe the penile nerve system
Point and Shoot
Erection is Parasympathetic S1-S3
Ejaculation is Sympathetic T12-L1
Function of bartolins gland
Mucoid secretions, lubricate vagina and vulva
What is the male equivalent of bartholins
Bulbourethral gland
Embryological origin of bartholins
Urogenital sinus
Histology of bartholins
Columnar epithelium ->transitional epithelium -> squamous epithelium
Nerve to bartholins
Pudendal
What is the female equivalent of the prostate gland
Skenes gland
Female equivalent of corpus spongiosum
Vestibular bulbs
Labia minor male equivalent
Urethral surface of penis
Labia Majora male equivalent
Scrotum
What do paramesonephric/mullerian ducts form when exposed to XX
Fallopian tubes, uterus, cervix, upper 1/3 vagina
In XX what happens if paramesonephric ducts fail to fuse
Didactic uterus/uterine septum
What do mesonephric/wolffian ducts do in presence of XY
Proliferate to form epididymis, vas deferens, seminal vesicles
What do mesonephric/wolffian ducts do in presence of XX
Regress
(Leave garters duct behind)
What do paramesonephric/mullerian ducts do in presence of XY
Regress
What does urogenital sinus form in males
Bladder, urethra, prostate, bulbourethral glands
What does urogenital sinus form in females
Bladder, urethra, skenes gland, bartolins
Describe the blood supply to the bladder
Superior vesical artery, vaginal artery supplementation, inferior vesicle artery
Venous drainage of the bladder
Vesical venous plexus
What nerves help fill the bladder
Sympathetic - hypogastric nerve T12-L2
Relaxes detrusor
What contracts detrusor muscle
Involuntary - parasympathetic, S2-S4 pelvic nerve
What controls voluntary micturation
Somatic, pudendal nerve, S2-S4
Where are skenes glands
Distal end of urethra in women
(2 mucous glands)
Main cell type of urethra
Stratified columnar epithelium (with transitional epithelium towards the top)
Innervation of urethra
Pudendal nerve and vesical plexus
Median nerve roots
C6-T1
Median nerve motor function
Flexor and pronator in anterior forearm compartment
Median nerve sensory function
Lateral aspect of palm, thumb, 2.5 fingers
Origins of median nerve
Axilla from brachial plexus
Location of median nerve relevant to brachial artety
Lateral in upper arm, cross at halfway, medial in lower arm
What happens if median nerve damaged
Can’t 👌
Can’t flex wrist
Spinal roots of ulnar nerve
C8-T1
Motor function of ulnar nerve
Small finger, half of ring finger, associated palm and dorsal hand
Sensory function of ulnar nerve
Medial one and a half fingers and associated palm area
Where does the ulnar nerve arise from
Brachial nerve within axilla region
Ulnar nerve journey through arm
Descends between axillary artery and vein, travels posterior to the elbow via ulnar tunnel, enters posterior compartment of arm
What deformity does damage to the ulnar nerve cause
Claw like hand deformity
What does ulnar nerve damage do to thumb
Weakens adduction
Radial nerve roots
C5-T1
Radial sensory innervation
Posterior forearm, lateral dorsuk.of hand, lateral surface of bottom half of three and half lateral digits
Radial motor innervation
Triceps and forearm extensors
How does the radial nerve travel in the upper arm
In the humerus radial groove
How does the radial nerve travel in the upper arm
In the humerus radial groove
What vessel accompanies the radial nerve
Deep brachial artery
How does the radial nerve enter the forarm
Anterior to the lateral epicondyle
Radial nerve divisions?
Deep - motor posterior forearm
Superficial - sensory dorsal hand
Radial nerve divisions?
Deep - motor posterior forearm
Superficial - sensory dorsal hand
What happens with damage to the radial nerve
Drop wrist
Musculotaneous nerve roots
C5-C7
Musculotaneous nerve motor innervation
Muscles.of anterior upper arm
Musculotaneous nerve sensory innervation
Lateral cutaneous nerve of the forarm
Musculotaneous nerve damage?
Weakened elbow and shoulder flexion
Weak forearm supination
What happens to ulnar nerve when arm flexed
Moves anteriorly
(Further from insertion site of posterior to sulcus)
Dermatomal level for innervation of anus
S5
If any voluntary contraction of anal sphincter then a spinal cord injury is motor Incomplete
What are the three main contributors to the inferior hypogastric plexus
Superior hypogastric plexus
Sacral splanchnic nerves
Pelvic splanchnic nervee
What is the widest part of the male urethra
Prostatic urethra
What is the flow of sperm from testes to ejaculation
Seminiferous tubules > rete testes > efferent tubules > epididymis > vas deferens > ejaculatory duct > urethra
What is the embryological origin of the anterior Pituitary
Rathkes pouch (ectoderm)
What is the embryological origin of the posterior pituitary
Infundibulum
What is the cremasteric fascia derived from
Internal oblique
What is the internal spermatic fascia derived from
Transversalis fascia
What type of joint is the pubic symphysis
Secondary cartilaginous
When a sten cell creates more stem cells, this process is called
Mitosis
In men what does LH act on
Leydig cells
What do.leydig cells do in summary
Convert cholesterol to testosterone
What cell in males does fsh act on
Sertoli cells
What does fsh do in Sertoli cells in summary
Create androgen bonding protein
What does androgen bonding protein do.
Makes testosterone less lipophilic so it stays within the Seminole tube lumen
What does testosterone do in the testes
Stimulate primary spermatocytes to become secondary spermatocytes (meiosis I)
Stimulate secondary spermatocytes to become spermatids (meiosis II)
Stimulate spermatids to become spermatozoa (spermatogenesis)
What cells make inhibin in men
Sertoli cells
What does inhibin do in men
Inhibits production of fsh by acting on hypothalamus and anterior Pituitary
What is another name for the suspensory ligament of the ovary?
Infundibulopelvic ligament
