Anatomy Flashcards

1
Q

Describe the greater pelvis

A

False pelvis as has no bony anterior (technically part of the abdominal cavity)
Shallow
Formed by the wings of the ilium

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2
Q

What 2 components make up the lesser (true) pelvis?

A

Pelvic cavity

Perineum

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3
Q

What is included as the perineum?

Describe the perineum and its borders

A

Anything below the pelvic diaphragm but still related to the pelvic outlet

Diamond shaped, divided into 2 triangles (urogenital and anal) at the imaginary inter tuberous line
Anteriorly: symphysis pubis
Anterolaterally: conjoint ischiopubic ramus, and ischial tuberosity
Posterolaterally: sacrotuberous ligament
Posteriorly: coccyx

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4
Q

Which 2 points are brought into line by the pelvis’ 60* tilt?

A

Anterior Superior Iliac Spine

Pubic tubercle

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5
Q

The pelvic floor (diaphragm) is a bowl-shaped group of sheet-like muscles that support the pelvic viscera, and assist with sphincters.
Which muscles make up the main group known as levator ani?

A

Pubococcygeus

Iliococcygeus

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6
Q

What is the function of puborectalis

A

Maintains the anorectal angle, helping faecal incontinence

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7
Q

What is the perineal body, and what is its function (x3)?

A

Central tendinous area where all pelvic floor muscles come together.

Important for the integrity of the pelvic floor
Provides support to the posterior vaginal wall
Attachment point for the anal sphincter and many muscles

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8
Q

Name the 4 different pelvic shapes, and when they occur

A

Android - heart shaped pelvic inlet. Seen in males
Arthropoid - oval long and thin. All born like this til puberty
Gynecoid - round. Female
Platypoid - oval wide and short. Caused by vitamin D deficiency

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9
Q

How are the true and diagonal conjugates measured, and what are their rough values?

A

True conjugate cannot be measured clinically. It is the actual space that the foetus’ head has to fit through (pelvic inlet). Measured from the top of pubic symphysis to the sacrum. ~10.5-11cm
Measured by subtracting the depth of pubic symphysis from the diagonal conjugate

Diagonal conjugate - distance from bottom of pubic symphysis to the sacrum. ~12.5cm

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10
Q

The internal iliac artery arises from the common iliac artery opposite the sacroiliac joint (L5/S1). It divides into anterior and posterior divisions. What do these 2 divisions supply?

A

Anterior: supplies pelvic organs and perineum
Posterior: supplies muscles, bones, and nerves

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11
Q

Where are the superficial and deep perineal pouches?

A

Superficial perineal pouch: space enclosed between the perineal membrane and Colles fascia

Deep perineal pouch: space enclosed between the perineal membrane and pelvic fascia

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12
Q

What is Colles fascia?

A

The continuation of inner membranous fascia scarper (once in the perineum)

(Fascia camper is the outer fatty fascia and is absent over the penis & scrotum)

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13
Q

List the contents of the superficial perineal pouch

A

Both:
Internal pudendal artery
Pudendal nerve

Male:
Crura and bulb of penis
Urethra
Testes
Scrotum
Female:
Crura of the clitoris
Bulb of the vestibule (split into 2 by the vagina)
Greater vestibular glands
Labia minora and majora 
Urethral and vaginal orifices
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14
Q

List the contents of the deep perineal pouch

A

Both:
Voluntary muscles supplied by pudendal nerve (sphincter urethrae, which encircles the urethra, and deep transversal perinei muscle)
Aperture for urethra and the external urethral sphincter

Male:
Bulbous ethereal glands and duct
Membranous part of urethra

Female:
Multiple sphincters
Second aperture for the vagina

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15
Q

What is the perineal body?

A

Central point of perineum (convergence of the ten muscles of the perineum forming a musculotendinous raphe in the median plane)

Lies 1/2” in front of the anal margin and close to the bulb of the penis/vestibule
Important in females for the support of the pelvic organs

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16
Q

Name the 5 bones of the pelvic girdle (belt)

A
Ilium
Ischium
Pubis
Sacrum
Coccyx
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17
Q

What is the wedge shaped space on either side of the anal canal called, and what is it filled with?

A

Ischioanal fossa
Filled with semi-solid fat, which acts as a cushion for the rectum and anal canal.
Loss of this fat will result in a prolapse

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18
Q

What is the significance of the communication between the ischioanal fossae?

A

Route for infection spread, resulting in a ‘horseshoe abscess’

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19
Q

What can be found on the lateral wall of the ischioanal fossa (about 1” above the ischial tuberosity)

A

The pudendal (Alcock’s) canal

20
Q

The perineum is divided into 2 triangles by which imaginary line?

A

Inter tuberous

21
Q

The urogenital triangle lies between the two ischiopubic rami. List the layers of superficial (skin) to deep (endopelvic fascia)

A

Skin
Fascia of Colles (deep fascia from the abdomen - attaches to the perineal membrane)
Superficial perineal pouch and its contents (everything below the perineal membrane)
Perineal membrane
Deep perineal pouch and its contents (enclosed by the perineal membrane - significant for infection spread)
Endopelvic fascia

22
Q

The perineal membrane sits below the pelvic floor and covers the urogenital triangle only. What are its functions?

A
  1. Attachment point for parts of the external genitalia and associated muscles
  2. Has apertures for the urethra (and vagina in females)
23
Q

List the 3 major ligaments of the pelvis

A
  1. Sacrospinal ligament - divides the greater and lesser sciatic foramina
  2. Sacrotuberous ligament - supports the sacrum, stops it moving under the body’s weight
  3. Anterior Superior Iliac ligaments - fan across the sacroiliac joints
24
Q

What 3 ‘pouches’ are formed by the peritoneum as it drapes over the pelvic organs

A
Vesico-uterine pouch (female)
Rectouterine pouch (female)
Vesicorectal pouch (male)
25
Which nerve supplies the pelvic and urogenital diaphragms, as well as the perineum Describe its course
Pudendal Nerve (S2-4) - the social nerve = sphincters and sex Travels through the sciatic notch (does not pierce levator ani), runs through the pudendal canal (close to the ischial spine in the lateral wall of the ischioanal fossa - important to know for pudendal blocks)
26
What structures can be palpated by rectal exam (4 for both, 3 in females, 1 for males)
``` Both: bladder haemorrhoids in anal canal polyps can check sphincter contractility ``` Female: uterus ovaries cervix Male: prostate
27
Define 'cystocoele' and 'rectocoele'
Cystocoele: bladder prolapsing into the vagina Rectocoele: rectum prolapsing into the vagina
28
What is the broad ligament?
A double layer of peritoneum that sweeps up and over the uterus, ovaries, and tubes
29
Describe the structure and different parts of the broad ligament
Double layer of peritoneum | Has an anterior and a posterior lamina
30
Describe the structure and different parts of the broad ligament
1. double layer of peritoneum 2. has an anterior and a posterior lamina 3. extends from sides of the uterus to the lateral pelvic walls Mesovarium - suspends the ovary from the posterior lamina Mesosalpinx - above the level of the ovary and mesovarium - sweeps over the fallopian tubes Mesometrium - largest portion, runs over the uterus
31
What are the contents of the broad ligament?
1. Uterine tubes 2. Ovaries 3. Uterine arteries and veins (also ovarian artery in the suspensory ligament) 4. Ovarian ligament, round ligament of the uterus, and suspensory ligaments of the ovary
32
What can be seen on speculum examination?
Top and bottom of the field you should see the SPECULUM EXTERNAL OS should be clearly visible in the centre (seen as a slit in multiparous women, and round in nulliparous women) ANTERIOR LIP of the cervix can be seen above the os (POSTERIOR LIP is seen below) A bit of redness around the external os is normal (SQUAMO-COLUMNAR JUNCTION)
33
Where is the PUBOCERVICAL ligament found, and what is its function?
It extends from the side of the cervix to the pubic symphysis Condensation of fascia, which stabilises the uterus in the pelvic cavity
34
Where and what is the TRANSVERSE CERVICAL ligament?
Extends from the cervix and vagina to the upper fascia of the pelvic diaphragm Thickening of the visceral pelvic fascia (cardinal ligament)
35
Where is the sacrocervical ligament, and what could result from damage to this or any other uterine ligament
Extends from sacrum to cervix as the name suggests Damage could result in a uterine prolapse
36
Where are the ovaries located?
In the ovarian fossa - a shallow depression of the lateral wall of the pelvis (below the pelvic brim) They are partly covered by peritoneum (broad ligament)
37
What is the position of the breast?
Base of the breast runs from rib 2 to rib 6 from mid-axillary line to lateral sternal edge. Breast tail continues into the axilla Divided into 4 quarters (through the nipple at T4): superior/inferior lateral/medial
38
What is the lymphatic drainage of the breast?
Lymph drains into the subariolar plexus and then into the axillary nodes: - Anterior (pectoral) - Posterior (subscapular) - Lateral (humeral) - Central (first ones, if these are clear, rest should be too) - Apical Then drains into INFRACLAVICULAR - SUBCLAVIAN THORACIC duct Can also drain into the parasternal nodes and over to the other breast, or down into the abdominal nodes
39
What are the Cooper's ligaments?
Suspensory ligaments in the breast Run from the clavicle (and the clavipectoral fascia) through and around the breast tissue to the dermis Suspends the breast, thus supporting its normal position
40
List the 8 layers related to the breast (from skin inwards)
``` Skin Breast Superficial fascia Retromammary space Deep fascia Pectoralis major Pectoralis minor and subclavicle Ribs and intercostal muscle ```
41
Breast carcinomas can invade the underlying layers, which ones are clinically significant?
Retromammary space and pectoral fascia | - clinically: breast moves superiorly upon contraction of pec major
42
What causes nipple inversion?
Ductal carcinoma invading the suspensory ligaments (can also cause pitting of the breast tissue)
43
How does peau d'orange come about?
lymphoedema - resulting in dimpled, puffy skin
44
Describe the normal structure of breast tissue
The breast is made up of many lobes - separated by suspensory ligaments (of Cooper), interlobular tissue, and fascia Each lobe contains a lactiferous duct, several lobules, and terminal ducts Myoepthithelial cells have contractile filaments, and move milk arund (under the influence of oxytocin) - they are found as a thin layer of cells above the basement membrane of the glandular eppithelium
45
Other than a carcinoma, what alternative diagnoses are there for breast lumps? (4)
1. Fibrocystic disease (normal hormonal changes/variation in >30s) - fibrous cysts can form - can get epithelial hyperplasia as well 2. Fibroadenoma (breast mouse) - develop from a lobule - glandular tissue and ducts grow over the lobule forming a solid lump 3. Lipoma 4. Traumatic fat necrosis
46
Describe the 3 layers of the uterine wall
Endometrium (the epithelium/mucosa) - single layer of columnar epithelium resting on the stroma - contains tubular glands (therefore susceptible to adenocarcinoma) Myometrium (thick smooth muscle layer - therefore susceptible to leiomyomatas/fibroids) Perimetrium (outer layer)