Anatomy Flashcards
Where is the quadrates lumborum(including origin and insertion)
Posterior abdominal wall. Origin iliac crest, insertion 12th rib and L1-L4 transverse processes
Muscles of posterior abdominal wall
Psoas, iliacus, quadratus, transversus
What nerve innervates iliacus
Femoral n (L2-L4)
Where do renal arteries leave the abdominal aorta
L1
Where do the gonadal arteries exit
L2
What is the blood supply of the posterior abdominal wall?
5 lumbar arteries L1-L5
What level does the abdominal aorta bifurcate and into what arteries
At L5 into the common iliacs
What are the urinary structures in relation to the peritoneum
Retro or infraperitoneal
Where does the RK sit in relation to ribs
Behind and below rib 12
Where does the LK sit in relation to the ribs
Behind ribs 11 and 12 (slightly higher as absence of liver on left)
Where do the ureters exit the kidneys
Transpyloric plane at L1
What are the kidneys covered in
Para-nephric fat
What is found in the renal hilum
Renal vein and artery, lymphatics, ANS,renal pelvis.
Where are the adrenal glands located
Superiorly on upper pole
Blood supply to the kidneys including relationships
Renal arteries and veins at L1 (transpyloroc plane). Veins are anterior to arteries. Arteries branch before the hilum into anterior and posterior branches.
Why are renal arteries posterior to the veins?
Because otherwise they would get occluded by the posterior abdominal wall
What is the nerve supply to the kidneys? and where does pain refer to?
Renal plexus (contributions from all over). Sympathetic- complicated. Parasympathetic Vagus nerve (CNX). Referred pain is described as flank pain.
Lymphatics of kidney
Para-aortic nodes @L1
Describe the path of the ureters
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.
Three sites of ureter constrictions where renal calculus can lodge
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
Blood supply of ureters
Renal artery/vein, gonadal artery/vein, superior vesical artery/vein
Nervous supply of ureters
Renal plexus and hypogastic plexus
Ureter pain referred to
L1/L2
What is the trigone?
Smooth muscle area at back of the bladder where there is no rugae. This is where the ureters enter.
Blood supply to the bladder
Artery-superior and inferior vesicular arteries branches of anterior branch of internal iliac
Nervous supply to bladder
ANS- inferior hypogastric plexus
Sympathetic- sacral splanchnic nerves
Parasympathetic pelvic splanchnic
What is sympathetic supply to pelvis region typically from
Sacral splanchnic nerve which arises from the sympathetic chain
What is the parasympathetic supply to the pelvis region typically?
Pelvic splanchnic nerves that arise from the sacral spinal nerves
What are the four subdivisions of the make urethra
Pre-prostatic
Prostatic
Membranous (through the deep perineal pouch)
Spongy (through the corpus spongiosum)
What division of the NS controls micturition
Parasympathetic, pelvic splanchnic (S2-S4)
What are the spinal levels that contribute to the Lumbar Plexus?
T12- L4
What nerve branch from L1 in lumbar plexus
Iliohypogastic and ilioinguinal
What does iliohypogastric innervate
Motor- The transversus abnominus and internal oblique
Sensory- lateral gluteal and pubis skin
What does the ilioinguinal innervate
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.
What nerve stems from L1 and L2
Genitofemoral. Two branches genital branch of genitofemoral and femoral branch of genitofemoral.
What does the genitofemoral nerve innervate
Motor- Cremasteric muscle
Sensory- scrotum/mons pubis, skin of upper anterior thigh
Course of the genitofemoral nerve
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.
What is the nerve that stems from L2-L3 and its path
Lateral femoral cutaneous nerve.
Lateral to psoas run inferior to iliac crest passing under ilioinguinal ligament
What does the lateral femoral cutaneous nerve supply
Skin on anterior and lateral thigh
What two nerves come from L2,L3, L4
Femoral and obturator
What does femoral nerve supply?
Sensory on anterior thigh and medical leg.
Motor for pectineus, illiacus, and anterior compartment of the thigh.
Only one that is medial to psoas
What does the obturator nerve supply?
Skin on medial thigh sensory
Motor obturator externus and medial compartment of the thigh
Name the layers of the abdominal wall superficial to deep
Skin Campers fascia Scarpers fascia External oblique Internal oblique Transversus abdominus Trasversali fascia Parietal peritoneum
Where is the pectineal line
From pubic tubercle sweeping arc running back to edge of pubic inlet
Where does the inguinal ligament run
From pubic tubercle to ASIS
What is the inguinal ligament formed from
The rolled edge of external oblique
Where is the lacunar ligament
Sweeping back posteriorly from inguinal ligament at pubic tubercle. Jones pectineal ligament
Where is the pectineal ligament
Continuation of the lacunar ligament in pelvic inlet
What is the inguinal canal
An oblique passage through the lower part of the abdominal wall
What is carried in the inguinal canal in females
The round ligament of the uterus (from the pelvis to the labia majora) and the ilioinguinal nerve
What is carried in the inguinal canal in males
The spermatic cord and ilioinguinal nerve
Where is the superficial inguinal ring found
In the aponeurosis of external oblique. Superior and lateral to the pubic tubercle
Where is the deep inguinal ring found
In the transversalis fascia. Half way between the pubic symphysis and the ASIS, 2 cm above inguinal ligament. Lateral to inferior epigastric artery.
What structure gives rise to the internal spermatic fascia
Transversalis fascia
What structure gives rise to the superficial spermatic fascia
The crus of the aponeurosis of the external oblique where it splits to form superficial inguinal ring
What structure gives rise to the muscular layer of the spermatic cord and what is this called
The internal oblique, the cremestaric muscle (of the spermatic cord)
What forms the conjoint tendon and where is it
The transverses abdominus and internal oblique fibres. They join at the pubic crest to form the conjoint tendon
What are the borders of the inguinal canal
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.
What is the clinical relevance of Hesselbachs triangle
It is the site of direct inguinal hernias. Corresponds to superficial inguinal ring where the is a weakened abdominal wall.
Name the borders of the Hesselbach triangle
Lateral border or rectus abdominus, inferior epigastric artery and the inguinal ligament.
Name the layers of the spermatic cord/scrotum
Tunica vaginalis (left over from peritoneum) Internal spermatic fascia (Transversalis fascia) Cremaster muscle (internal oblique) External spermatic fascia (external oblique)
What are the contents of the spermatic cord
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
Describe the cremasteric reflex
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.
Where does a direct inguinal hernia occur?
Medial to inferior epigastric artery. Abdominal contents herniate through weak spot in the fascia of posterior wall of inguinal canal hesselbachs triangle
Where does an indirect inguinal hernia occur?
Protrusion of the abdominal contents through deep inguinal ring through the entirety of the inguinal cord into scrotum.
Lateral to inferior epigastric
Describe femoral hernia
Inferior to inguinal ligament.
What are the borders which define, inferiorly, the true pelvis (the pelvic inlet)
Sacral promontory, alas of sacrum, arcuate line, pectineal line, pubic tubercle, pubic crest, pubic symphysis.
What is the degree of the pelvic tilt and what landmarks are in line
60 degrees
ASIS and pubic tubercles
Where is the sacrospinous ligament
Sacrum to ischial spines
Where is sacrotuberous ligament
Sacrum to ischial tuberosities
What forms the greater sciatic foramen
The greater sciatic notch and the sacrospinous ligament
What are the muscles of the wall of the pelvis
Piriformis and obturator internus
Where do most nerves that exit the pelvis pass
Underneath piriformis via greater sciatic foramen
What forms the lesser sciatic foramen
The lesser sciatic notch and the sacrotuberous ligament and the sacrospinous ligament.
What is the path of the pudendal nerve
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.
Name the five nerves in lectures that have a relation to piriformis and obturator interns and their relations
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
Describe the function of the pudendal nerve and nerve root
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.
Describe branches of the common iliac.
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
How to remember branches of anterior division 3,3,3
3 Vesicular Umbilical, superior and inferior vesical
3 visceral- uterine, middle rectal and vaginal/prostatic
3 parietal- obturator, internal pudendal, inferior gluteal
In males what do the inferior vesical artery supply
Prostate, seminal vesicles, ductus deferens.
Where do the gonadal arteries stem from
Abdominal aorta at L2
Branches of the posterior division
Three. Only need to know superior gluteal.
Describe the venous drainage of the pelvic viscera
Each viscera has a venous plexus (bladder, prostate, rectum, uterus, vagina). All drain to the internal iliac veins
What are the nerve roots of the sacral plexus
L4 and 5, S1- S4
What are the four nerves of the sacral plexus we need to know
Superior and inferior gluteal nerves, sciatic nerve, pudendal nerve and nerve to levator ani/coccygeus
What is the clinical significance of damage to the nerve to the levator anti/ coccygeus
If damaged i.e. in pregnancy risk of prolapse of pelvic organs as the muscles it innervates support them
What does the pudendal nerve give off
Inferior rectal, perineal, dorsal nerve to clitoris/penis, scrotal/labial branches
Sympathetic supply to pelvic viscera
L1 and L2 fibres that descend to form superior hypogastric plexus. Also sacral splanchnic nerves from sympathetic chain.
Parasympathetic supply to pelvic viscera
From S2-S4 pelvic splanchnic nerves ascend via hypogastric nerves to superior hypogastric plexus and into ado. Also directly into inferior hypogastric plexus
Saddle fractures. If you smash up your pubic symphysis whats at risk
Bladder
Saddle fractures. If you smash up your sacroiliac joint…
Ureters, also where common iliac bifurcates into internal and external iliac… bleeding
Boundaries of the pelvic outlet
Pubic symphysis, ischiopubic rami, ischial tuberosity, ST ligament, coccyx
Borders of the urogenital triangle
Pubic symphysis, ischiopubic rami, ischial tuberosities
Borders of the anal triangle
Ischial tuberosities, coccyx
Describe the perineal body and what the muscles attach into
It is a fibrous band of its between vagina and anus (scrotum and anus) Levator ani,bulbospongious, external anal sphincter, perineal muscle.
What muscle makes the pelvic floor
Levator ani
3 divisions of the levator ani
ischiococcygeus, iliococcygeus, pubococcygeus
Levator ani is innervated by ?
Pudendal nerve (s2,s3,s4) and nerve to levator ani
Important muscle that is a division of pubococcygeus (from LA)
Puborectalis, loops around the rectum important for fecal continence.
Describe the external anal sphincter
Skeletal muscle, innervated by pudendal nerve S2-4, inferior rectal branch
Describe the internal anal sphincter
Smooth muscle under autonomic nervous control.
What is the ischialanal fossa?
Fatty triangle bordered by obturator internus laterally, levator ani and external anal sphincter medially. Holds pudendal nerves and vessels
Surface landmarks of ischioanal fossa
Pubic body to ischial tuberosity, to coccyx.
Avoid the lateral apex as this is where pudendal vessels are found.
When the rectum pierces the pelvic floor what is known as
Anal canal
Arterial supply to rectum
Superior rectal from inferior mesenteries, inferior rectal from internal pudendal.
Lymphatics of rectum
Pre aortic nodes at L3, Internal iliac nodes. Skin superficial inguinal nodes
Rectal/ anal venous drainage
Inferior rectal vein, superior rectal vein
Describe the function and location of the perineal membrane
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.
Describe the branches of the internal pudendal
Terminal branch of anterior division of internal iliac. Main branches are inferior rectal, perineal, dorsal artery of clitoris/ penis
Describe the branches of the pudendal nerve
inferior rectal, perineal, dorsal n. of clitoris/ penis
Damage to pudendal nerves dermatomes
Saddle anaesthesia perineal region and down thighs.
Name the two pouches formed by the peritoneum in females
Vesicouterine pouch and rectouterine pouch (pouch of douglas)
Name the pouch formed by peritoneum in males
Vesicorectal pouch
Name two muscles relevant to external genitalia
Ischiocavernosus- aids erection/ tenses vagina
Bulbospongiosus- erection and ejaculation, clitoral erection and feelings of orgasm
What is the erectile tissue in females
Crus of clitoris, contributes to body of clitoris.
Bulb of vestibule
What is the erectile tissue in males
Crus of penis, becomes corpus cavernosa
Bulb of penis, become the corpus spongiosum and glans penis (contains urethra)
Superficial fascia of scrotum continuous with what ado layer
scarpas fascia- becomes dartos fascia
What does the scrotum receive its blood supply from
internal and external pudendal (from femoral) arteries
What are the layers of the scrotum
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.
Path of sperm from testes
Seminiferous tubule, Lobule, rete testes, epididymis, vas deferens
Path of vas def
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
What are the seminal vesicles and where are they
Secrete liquid component of semen, and fructose.
Sit posterior to the bladder, superior to the prostate
When is the ejaculatory duct formed
Once the seminal vesical and the vas def join
Location function and structures found. Prostate gland
Inferior to bladder, releases proteolytic enzymes and acid phosphates, the prostate contains the prostatic urethra and ejaculatory duct.
Blood supply of prostate
Branches of internal iliac (internal pudendal, middle rectal, inferior vesicle). Veins deep dorsal vein of penis, plexus, internal iliac vein.
Simple approximation of visceral lymphatic drainage in pelvis
Internal iliac artery- internal iliac nodes
What is the exception to lymphatics draining in pelvic viscera
Ovaries and testes their arteries (gonadal arteries) exit abdominal aorta at L2 so their lymph drains to aortic nodes at L2
Skin of penis and and wall of scrotum lymphatics
to superficial inguinal nodes
Glans penis lymphatics
Deep inguinal and iliac nodes
Describe the broad ligament
It is where the abdominal peritoneum sweeps over the uterus, fallopian tubes, and ovaries. Has subdivisions that all start with meso.
Mesovarium, mesosalpinx, mesometrium.
Describe the round ligament
Passes through the inguinal canal and creates ante version
What are the ligaments of the ovary
Ovarian ligament, suspensary ligament of the ovary, mesovarium.
Blood supply of the ovary
Ovarian arteries from Abd. aorta at L2. Ovarian vein drains to IVC on right and left renal vein on left.
Nerves of ovaries
Ovarian plexus
What is found in the vestibule
Urethral orifice, vaginal orifice,
greater vestibular glands, clitoris
Layers and functions of ureter
- 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)
