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Anatomy Flashcards

1
Q

Where is the quadrates lumborum(including origin and insertion)

A

Posterior abdominal wall. Origin iliac crest, insertion 12th rib and L1-L4 transverse processes

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2
Q

Muscles of posterior abdominal wall

A

Psoas, iliacus, quadratus, transversus

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3
Q

What nerve innervates iliacus

A

Femoral n (L2-L4)

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4
Q

Where do renal arteries leave the abdominal aorta

A

L1

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5
Q

Where do the gonadal arteries exit

A

L2

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6
Q

What is the blood supply of the posterior abdominal wall?

A

5 lumbar arteries L1-L5

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7
Q

What level does the abdominal aorta bifurcate and into what arteries

A

At L5 into the common iliacs

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8
Q

What are the urinary structures in relation to the peritoneum

A

Retro or infraperitoneal

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9
Q

Where does the RK sit in relation to ribs

A

Behind and below rib 12

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10
Q

Where does the LK sit in relation to the ribs

A

Behind ribs 11 and 12 (slightly higher as absence of liver on left)

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11
Q

Where do the ureters exit the kidneys

A

Transpyloric plane at L1

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12
Q

What are the kidneys covered in

A

Para-nephric fat

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13
Q

What is found in the renal hilum

A

Renal vein and artery, lymphatics, ANS,renal pelvis.

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14
Q

Where are the adrenal glands located

A

Superiorly on upper pole

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15
Q

Blood supply to the kidneys including relationships

A

Renal arteries and veins at L1 (transpyloroc plane). Veins are anterior to arteries. Arteries branch before the hilum into anterior and posterior branches.

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16
Q

Why are renal arteries posterior to the veins?

A

Because otherwise they would get occluded by the posterior abdominal wall

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17
Q

What is the nerve supply to the kidneys? and where does pain refer to?

A 
Renal plexus (contributions from all over). 
Sympathetic- complicated. Parasympathetic Vagus nerve (CNX). Referred pain is described as flank pain.
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18
Q

Lymphatics of kidney

A

Para-aortic nodes @L1

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19
Q

Describe the path of the ureters

A

Leave the kidneys at L1, extends vertically down the psoas muscle, crosses bifurcation of the common iliac artery to enter bladder in the inferior surface.

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20
Q

Three sites of ureter constrictions where renal calculus can lodge

A

Junction of the ureters and the renal pelvis
Where the ureters cross pelvic brim (at bifurcation of common iliac)
As the enter the wall of the bladder

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21
Q

Blood supply of ureters

A

Renal artery/vein, gonadal artery/vein, superior vesical artery/vein

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22
Q

Nervous supply of ureters

A

Renal plexus and hypogastic plexus

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23
Q

Ureter pain referred to

A

L1/L2

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24
Q

What is the trigone?

A

Smooth muscle area at back of the bladder where there is no rugae. This is where the ureters enter.

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25
Q

Blood supply to the bladder

A

Artery-superior and inferior vesicular arteries branches of anterior branch of internal iliac

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26
Q

Nervous supply to bladder

A

ANS- inferior hypogastric plexus
Sympathetic- sacral splanchnic nerves
Parasympathetic pelvic splanchnic

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27
Q

What is sympathetic supply to pelvis region typically from

A

Sacral splanchnic nerve which arises from the sympathetic chain

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28
Q

What is the parasympathetic supply to the pelvis region typically?

A

Pelvic splanchnic nerves that arise from the sacral spinal nerves

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29
Q

What are the four subdivisions of the make urethra

A

Pre-prostatic
Prostatic
Membranous (through the deep perineal pouch)
Spongy (through the corpus spongiosum)

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30
Q

What division of the NS controls micturition

A

Parasympathetic, pelvic splanchnic (S2-S4)

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31
Q

What are the spinal levels that contribute to the Lumbar Plexus?

A

T12- L4

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32
Q

What nerve branch from L1 in lumbar plexus

A

Iliohypogastic and ilioinguinal

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33
Q

What does iliohypogastric innervate

A

Motor- The transversus abnominus and internal oblique

Sensory- lateral gluteal and pubis skin

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34
Q

What does the ilioinguinal innervate

A

Ilioinguinal pierces internal oblique to enter the inguinal canal and spermatic cord.
It innervates motor- transversus abdominus, and internal oblique.
Sensory- skin of medial thigh, root of penis, scrotum or mons pubis/ labia majora.

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35
Q

What nerve stems from L1 and L2

A

Genitofemoral. Two branches genital branch of genitofemoral and femoral branch of genitofemoral.

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36
Q

What does the genitofemoral nerve innervate

A

Motor- Cremasteric muscle

Sensory- scrotum/mons pubis, skin of upper anterior thigh

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37
Q

Course of the genitofemoral nerve

A

Emerges through and runs on top of psoas, genital branch enters spermatic cord to innervate cremaster muscle and give sensory to genital skin.
Femoral branch passes under the inguinal ligament to the thigh.

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38
Q

What is the nerve that stems from L2-L3 and its path

A

Lateral femoral cutaneous nerve.

Lateral to psoas run inferior to iliac crest passing under ilioinguinal ligament

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39
Q

What does the lateral femoral cutaneous nerve supply

A

Skin on anterior and lateral thigh

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40
Q

What two nerves come from L2,L3, L4

A

Femoral and obturator

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41
Q

What does femoral nerve supply?

A

Sensory on anterior thigh and medical leg.
Motor for pectineus, illiacus, and anterior compartment of the thigh.
Only one that is medial to psoas

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42
Q

What does the obturator nerve supply?

A

Skin on medial thigh sensory

Motor obturator externus and medial compartment of the thigh

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43
Q

Name the layers of the abdominal wall superficial to deep

A 
Skin
Campers fascia
Scarpers fascia
External oblique
Internal oblique
Transversus abdominus
Trasversali fascia
Parietal peritoneum
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44
Q

Where is the pectineal line

A

From pubic tubercle sweeping arc running back to edge of pubic inlet

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45
Q

Where does the inguinal ligament run

A

From pubic tubercle to ASIS

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46
Q

What is the inguinal ligament formed from

A

The rolled edge of external oblique

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47
Q

Where is the lacunar ligament

A

Sweeping back posteriorly from inguinal ligament at pubic tubercle. Jones pectineal ligament

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48
Q

Where is the pectineal ligament

A

Continuation of the lacunar ligament in pelvic inlet

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49
Q

What is the inguinal canal

A

An oblique passage through the lower part of the abdominal wall

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50
Q

What is carried in the inguinal canal in females

A

The round ligament of the uterus (from the pelvis to the labia majora) and the ilioinguinal nerve

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51
Q

What is carried in the inguinal canal in males

A

The spermatic cord and ilioinguinal nerve

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52
Q

Where is the superficial inguinal ring found

A

In the aponeurosis of external oblique. Superior and lateral to the pubic tubercle

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53
Q

Where is the deep inguinal ring found

A

In the transversalis fascia. Half way between the pubic symphysis and the ASIS, 2 cm above inguinal ligament. Lateral to inferior epigastric artery.

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54
Q

What structure gives rise to the internal spermatic fascia

A

Transversalis fascia

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55
Q

What structure gives rise to the superficial spermatic fascia

A

The crus of the aponeurosis of the external oblique where it splits to form superficial inguinal ring

56
Q

What structure gives rise to the muscular layer of the spermatic cord and what is this called

A

The internal oblique, the cremestaric muscle (of the spermatic cord)

57
Q

What forms the conjoint tendon and where is it

A

The transverses abdominus and internal oblique fibres. They join at the pubic crest to form the conjoint tendon

58
Q

What are the borders of the inguinal canal

A

Anterior wall- aponeurosis of external oblique and lateral 1/3 of internal oblique
Posterior wall- transversalsis fascia and conjoint tendon
Roof- fibres of transversus abdominus and internal oblique
Floor- inguinal ligament and lacunar ligament.

59
Q

What is the clinical relevance of Hesselbachs triangle

A

It is the site of direct inguinal hernias. Corresponds to superficial inguinal ring where the is a weakened abdominal wall.

60
Q

Name the borders of the Hesselbach triangle

A

Lateral border or rectus abdominus, inferior epigastric artery and the inguinal ligament.

61
Q

Name the layers of the spermatic cord/scrotum

A 
Tunica vaginalis (left over from peritoneum)
Internal spermatic fascia (Transversalis fascia)
Cremaster muscle (internal oblique)
External spermatic fascia (external oblique)
62
Q

What are the contents of the spermatic cord

A

Three arteries- testicular artery, artery of vas def, cremesteric artery.
Three nerves- genital branch of genitofemoral, sympathetic nerves from the testicular plexus, ilioinguinal nerve (not within cord)
3 structures- vas def, lymph, tunica vaginalis
1 vein- pampiniform plexus

63
Q

Describe the cremasteric reflex

A

Stroke the superior medial thigh to stimulate the sensory fibres of the femoral branch of genitofemoral and the ilioinguinal n. This in turn stimulates motor fibres of genital branch of genitofemoral and the cremaster muscle contracts elevating teste on the ipsilateral side.
In testicular torsion the reflex is absent.

64
Q

Where does a direct inguinal hernia occur?

A

Medial to inferior epigastric artery. Abdominal contents herniate through weak spot in the fascia of posterior wall of inguinal canal hesselbachs triangle

65
Q

Where does an indirect inguinal hernia occur?

A

Protrusion of the abdominal contents through deep inguinal ring through the entirety of the inguinal cord into scrotum.
Lateral to inferior epigastric

66
Q

Describe femoral hernia

A

Inferior to inguinal ligament.

67
Q

What are the borders which define, inferiorly, the true pelvis (the pelvic inlet)

A

Sacral promontory, alas of sacrum, arcuate line, pectineal line, pubic tubercle, pubic crest, pubic symphysis.

68
Q

What is the degree of the pelvic tilt and what landmarks are in line

A

60 degrees

ASIS and pubic tubercles

69
Q

Where is the sacrospinous ligament

A

Sacrum to ischial spines

70
Q

Where is sacrotuberous ligament

A

Sacrum to ischial tuberosities

71
Q

What forms the greater sciatic foramen

A

The greater sciatic notch and the sacrospinous ligament

72
Q

What are the muscles of the wall of the pelvis

A

Piriformis and obturator internus

73
Q

Where do most nerves that exit the pelvis pass

A

Underneath piriformis via greater sciatic foramen

74
Q

What forms the lesser sciatic foramen

A

The lesser sciatic notch and the sacrotuberous ligament and the sacrospinous ligament.

75
Q

What is the path of the pudendal nerve

A

From ventral rami of S2, S3, S4 (keeps the penis of the floor). Passes superior to sacrospinous ligament tucks behind it into the greater sciatic foramen, then moves medially into lesser sciatic foramen where it innervates the pelvic region.

76
Q

Name the five nerves in lectures that have a relation to piriformis and obturator interns and their relations

A

Superior gluteal nerve- superior to piriformis.
Sciatic nerve, posterior cutaneous nerve to the thigh, pudendal nerve, inferior gluteal nerve- inferior to piriformis superior to sacrospinous.
Obturator nerve anterior to sacrospinous to innervate the obturator muscle

77
Q

Describe the function of the pudendal nerve and nerve root

A

Sacral plexus, S2-S4. Main nerve of the perineal muscles.
Carries sensation of the external genitalia and perineum and anus as well as motor supply to urethral and anal sphincters. Damage can cause fecal incontinence.

78
Q

Describe branches of the common iliac.

A

Common iliac bifurcates into internal and external. Internal relevant to pelvis.
Internal iliac bifurcates into anterior and posterior divisions.
Posterior doesn’t do much.
Anterior division gives off umbilical (gives off 2 vesical), obturator, inferior vesical (uterine in f.) gives off vaginal/prostatic, middle rectal. Then bifurcates to terminal branches internal pudendal and inferior gluteal. Inferior pudendal gives off inferior rectal

79
Q

How to remember branches of anterior division 3,3,3

A

3 Vesicular Umbilical, superior and inferior vesical
3 visceral- uterine, middle rectal and vaginal/prostatic
3 parietal- obturator, internal pudendal, inferior gluteal

80
Q

In males what do the inferior vesical artery supply

A

Prostate, seminal vesicles, ductus deferens.

81
Q

Where do the gonadal arteries stem from

A

Abdominal aorta at L2

82
Q

Branches of the posterior division

A

Three. Only need to know superior gluteal.

83
Q

Describe the venous drainage of the pelvic viscera

A

Each viscera has a venous plexus (bladder, prostate, rectum, uterus, vagina). All drain to the internal iliac veins

84
Q

What are the nerve roots of the sacral plexus

A

L4 and 5, S1- S4

85
Q

What are the four nerves of the sacral plexus we need to know

A

Superior and inferior gluteal nerves, sciatic nerve, pudendal nerve and nerve to levator ani/coccygeus

86
Q

What is the clinical significance of damage to the nerve to the levator anti/ coccygeus

A

If damaged i.e. in pregnancy risk of prolapse of pelvic organs as the muscles it innervates support them

87
Q

What does the pudendal nerve give off

A

Inferior rectal, perineal, dorsal nerve to clitoris/penis, scrotal/labial branches

88
Q

Sympathetic supply to pelvic viscera

A

L1 and L2 fibres that descend to form superior hypogastric plexus. Also sacral splanchnic nerves from sympathetic chain.

89
Q

Parasympathetic supply to pelvic viscera

A

From S2-S4 pelvic splanchnic nerves ascend via hypogastric nerves to superior hypogastric plexus and into ado. Also directly into inferior hypogastric plexus

90
Q

Saddle fractures. If you smash up your pubic symphysis whats at risk

A

Bladder

91
Q

Saddle fractures. If you smash up your sacroiliac joint…

A

Ureters, also where common iliac bifurcates into internal and external iliac… bleeding

92
Q

Boundaries of the pelvic outlet

A

Pubic symphysis, ischiopubic rami, ischial tuberosity, ST ligament, coccyx

93
Q

Borders of the urogenital triangle

A

Pubic symphysis, ischiopubic rami, ischial tuberosities

94
Q

Borders of the anal triangle

A

Ischial tuberosities, coccyx

95
Q

Describe the perineal body and what the muscles attach into

A

It is a fibrous band of its between vagina and anus (scrotum and anus) Levator ani,bulbospongious, external anal sphincter, perineal muscle.

96
Q

What muscle makes the pelvic floor

A

Levator ani

97
Q

3 divisions of the levator ani

A

ischiococcygeus, iliococcygeus, pubococcygeus

98
Q

Levator ani is innervated by ?

A

Pudendal nerve (s2,s3,s4) and nerve to levator ani

99
Q

Important muscle that is a division of pubococcygeus (from LA)

A

Puborectalis, loops around the rectum important for fecal continence.

100
Q

Describe the external anal sphincter

A

Skeletal muscle, innervated by pudendal nerve S2-4, inferior rectal branch

101
Q

Describe the internal anal sphincter

A

Smooth muscle under autonomic nervous control.

102
Q

What is the ischialanal fossa?

A

Fatty triangle bordered by obturator internus laterally, levator ani and external anal sphincter medially. Holds pudendal nerves and vessels

103
Q

Surface landmarks of ischioanal fossa

A

Pubic body to ischial tuberosity, to coccyx.

Avoid the lateral apex as this is where pudendal vessels are found.

104
Q

When the rectum pierces the pelvic floor what is known as

A

Anal canal

105
Q

Arterial supply to rectum

A

Superior rectal from inferior mesenteries, inferior rectal from internal pudendal.

106
Q

Lymphatics of rectum

A

Pre aortic nodes at L3, Internal iliac nodes. Skin superficial inguinal nodes

107
Q

Rectal/ anal venous drainage

A

Inferior rectal vein, superior rectal vein

108
Q

Describe the function and location of the perineal membrane

A

The anterior deficit of the pelvic floor means that there needs to be another diaphragm to stop the pelvic contents prolapsing. This is provided by the perineal membrane which covers the urogenital triangle. There is a slight deficit anteriorly that allows the deep dorsal veins of penis/ clitoris to pass.

109
Q

Describe the branches of the internal pudendal

A

Terminal branch of anterior division of internal iliac. Main branches are inferior rectal, perineal, dorsal artery of clitoris/ penis

110
Q

Describe the branches of the pudendal nerve

A

inferior rectal, perineal, dorsal n. of clitoris/ penis

111
Q

Damage to pudendal nerves dermatomes

A

Saddle anaesthesia perineal region and down thighs.

112
Q

Name the two pouches formed by the peritoneum in females

A

Vesicouterine pouch and rectouterine pouch (pouch of douglas)

113
Q

Name the pouch formed by peritoneum in males

A

Vesicorectal pouch

114
Q

Name two muscles relevant to external genitalia

A

Ischiocavernosus- aids erection/ tenses vagina

Bulbospongiosus- erection and ejaculation, clitoral erection and feelings of orgasm

115
Q

What is the erectile tissue in females

A

Crus of clitoris, contributes to body of clitoris.

Bulb of vestibule

116
Q

What is the erectile tissue in males

A

Crus of penis, becomes corpus cavernosa

Bulb of penis, become the corpus spongiosum and glans penis (contains urethra)

117
Q

Superficial fascia of scrotum continuous with what ado layer

A

scarpas fascia- becomes dartos fascia

118
Q

What does the scrotum receive its blood supply from

A

internal and external pudendal (from femoral) arteries

119
Q

What are the layers of the scrotum

A

Internal spermatic fascia from transversals fascia
Cremasti fascia from internal oblique
External spermatic fascia form external oblique aponeurosis
Superficial fascia from scarpas fascia (becomes dartos fascia)
Dartos fascia is continuous posteriorly with deep fascia of the perineum.

120
Q

Path of sperm from testes

A

Seminiferous tubule, Lobule, rete testes, epididymis, vas deferens

121
Q

Path of vas def

A

Travels in spermatic cord through inguinal canal, right and left pass on each lateral side of bladder passing over the external iliac vessels, superior to the urethra (water under the bridge) where they enter the duct from seminal vesicles to form the ejaculatory duct. ED into prostate to join the urethra

122
Q

What are the seminal vesicles and where are they

A

Secrete liquid component of semen, and fructose.

Sit posterior to the bladder, superior to the prostate

123
Q

When is the ejaculatory duct formed

A

Once the seminal vesical and the vas def join

124
Q

Location function and structures found. Prostate gland

A

Inferior to bladder, releases proteolytic enzymes and acid phosphates, the prostate contains the prostatic urethra and ejaculatory duct.

125
Q

Blood supply of prostate

A

Branches of internal iliac (internal pudendal, middle rectal, inferior vesicle). Veins deep dorsal vein of penis, plexus, internal iliac vein.

126
Q

Simple approximation of visceral lymphatic drainage in pelvis

A

Internal iliac artery- internal iliac nodes

127
Q

What is the exception to lymphatics draining in pelvic viscera

A

Ovaries and testes their arteries (gonadal arteries) exit abdominal aorta at L2 so their lymph drains to aortic nodes at L2

128
Q

Skin of penis and and wall of scrotum lymphatics

A

to superficial inguinal nodes

129
Q

Glans penis lymphatics

A

Deep inguinal and iliac nodes

130
Q

Describe the broad ligament

A

It is where the abdominal peritoneum sweeps over the uterus, fallopian tubes, and ovaries. Has subdivisions that all start with meso.
Mesovarium, mesosalpinx, mesometrium.

131
Q

Describe the round ligament

A

Passes through the inguinal canal and creates ante version

132
Q

What are the ligaments of the ovary

A

Ovarian ligament, suspensary ligament of the ovary, mesovarium.

133
Q

Blood supply of the ovary

A

Ovarian arteries from Abd. aorta at L2. Ovarian vein drains to IVC on right and left renal vein on left.

134
Q

Nerves of ovaries

A

Ovarian plexus

135
Q

What is found in the vestibule

A

Urethral orifice, vaginal orifice,

greater vestibular glands, clitoris

136
Q

Layers and functions of ureter

A
  • Transitional epithelium (folding permits expansion and contraction)
  • Mucous membrane (lubrication, protection from urine and pathogens)
  • Subepithelial connective tissue/lamina propria (elastic)
  • Smooth muscle layers (contractile inner longitudnal outer circular)
  • Outside layer of adventitia (elastic and habours blood supply)

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