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Anatomy Flashcards

1
Q

What does the bony pelvis consist of?

A

2 hip bones
Sacrum
Coccyx

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2
Q

What is each hip bone a fusion of?

A

Ilium
Ischium
Pubis

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3
Q

What is the ischiopubic ramus made up of?

A

Both ischium and pubis

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4
Q

What ligament attaches to the pubic tubercle?

A

Inguinal ligament

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5
Q

Where does the inguinal ligament attach between?

A

The ASIS and pubic tubercle

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6
Q

Where are the ischial spines palpable?

A

On vaginal examination, at about a finger breadth into the vagina (approx. 4 and 8oclock positions)-also pudendal nerve

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7
Q

Where are the attachments of the sacrospinous ligament?

A

Sacrum and ischial spine

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8
Q

Where are the attachments of the sacrotuberous ligament?

A

Sacrum and ischial tuberosity

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9
Q

What is the function of the sacrotuberous and sacrospinous ligaments?

A

Ensure inferior sacrum is not pushed superiorly when weight is suddenly transferred vertically through vertebral column (eg. jumping, later pregnancy)

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10
Q

What 2 foraminae do the sacrotuberous and sacrospinous ligaments form?

A

Greater and lesser sciatic foraminae

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11
Q

What forms the pelvic inlet?

A

Sacral promontory
Ilium
Superior pubic ramus
Pubic symphysis

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12
Q

What forms the pelvic outlet?

A 
Pubic symphysis
Ischiopubic ramus
Ischial tuberosities
Sacrootuberous ligaments
Coccyx
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13
Q

What part of the pelvic cavity does levator ani form?

A

Pelvic floor- musculofascial inferior part

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14
Q

What are the functions of the pelvis?

A

Upper body support
Transference of weight from vertebral column to femurs
Attachment for muscles of location and abdo wall
Attachment for external genitalia
Protection of pelvic organs and associated structures
Passage for childbirth

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15
Q

What are the key differences between the female and male pelvis?

A

AP and transverse diameters are larger
Subpubic angle is wider
Pelvic cavity is shallower

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16
Q

What is moulding?

A

The movement of one bone over another to allow the foetal head to pass through the pelvis during labour

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17
Q

Moulding is allowed due to the presence of what?

A

Sutures and fontanelles

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18
Q

What is the vertex?

A

An area of foetal skull- outlined by the anterior and posterior fontanelles and the parietal eminences

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19
Q

Which is longer-the occipofrontal diameter or the biparietal?

A

Occipitofrontal

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20
Q

At the pelvic inlet, is the transverse of AP diameter wider?

A

Transverse

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21
Q

The foetus should enter the pelvic cavity facing what direction?

A

Either right or left (transverse)

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22
Q

What is the station?

A

The distance of the foetal head from the ischial spines

-ve means head is superior, +ve means head is inferior

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23
Q

What should the foetal head do whilst descending through the pelvic cavity?

A

Rotate

Be in a flexed position e.g. chin on chest

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24
Q

At the pelvic outlet is the AP or transverse diameter wider?

A

AP

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25
Q

In what position should the baby ideally leave the pelvic cavity?

A

Occipitoanterior position

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26
Q

During delivery should the foetal head be in flexion or extension?

A

Extension

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27
Q

What happens once baby’s head is delivered?

A

There is a further rotation so that the shoulders and rest of the baby can then be delivered

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28
Q

What parts of the female reproductive system are within the pelvic cavity?

A

Ovaries
Uterine tubes
Uterus
Superior part of vagina

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29
Q

What parts of the female reproductive system are within the perineum?

A 
Inferior part of vagina
Perineal muscles
Bartholin's glands
Clitoris
Labia
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30
Q

Fluid collection in the pouch of Douglas can be drained via a needle passed through what in females?

A

Posterior fornix of the vagina

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31
Q

What is the broad ligament of the uterus?

A

Double layer of the peritoneum

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32
Q

Where does the broad ligament extend between?

A

The uterus and the lateral walls and floor of the pelvis

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33
Q

What is the function of the broad ligament?

A

Helps maintain the uterus in its correct midline position

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34
Q

What is contained within the broad ligament?

A

The uterine tubes and the proximal part of the round ligament

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35
Q

What is the round ligament?

A

An embryological remnant

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36
Q

Where does the round ligament attach?

A

The lateral aspect of the uterus, and passes through the deep inguinal ring to attach to the superficial tissue of the female perineum

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37
Q

Where does implantation of the zygote occur?

A

Body of the uterus

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38
Q

What 3 layers of support hold thee uterus in place?

A

Number of strong ligaments e.g. uterosacral ligaments
Endopelvic fascia
Pelvic floor muscles e.g. levator ani

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39
Q

What are the two most common positions of the uterus?

A

Anteverted

Anteflexed

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40
Q

What are some normal variations in position of the uterus?

A

Retroverted

Retroflexed

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41
Q

What state are the walls of the vagina usually in?

A

Collapsed

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42
Q

What zone is sampled during a cervical smear?

A

Squamo columnar junction (transformation zone)

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43
Q

Do the uterine tubes usually lie symmetrically?

A

No

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44
Q

What is a bilateral salpingo-oophorectomy?

A

Removal of both uterine tubes and ovaries

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45
Q

What is a unilateral salpingectomy?

A

Removal of one of the uterine tubes

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46
Q

Where are the fimbriae open?

A

Into the peritoneal cavity

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47
Q

What size and shape are the ovaries?

A

Almond like

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48
Q

What do the ovaries secrete?

A

Oestrogen and progesterone in response to FSH and LH

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49
Q

Where do ovaries develop?

A

Posterior abdominal wall and move onto the lateral wall of pelvis, then onto the round ligament

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50
Q

Where is the ovum released?

A

Directly into the peritoneal cavity to be picked up by the fimbriae of the uterine tube

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51
Q

What is the fornix?

A

Space around the cervix

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52
Q

What are the 4 parts of the fornix?

A

Anterior
Posterior
2 Lateral

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53
Q

What is the perineum divided into?

A

Superficial and deep pouches

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54
Q

What is the levator ani muscle made up of?

A

Number of small muscles

Skeletal

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55
Q

What does levator ani form?

A

The majority of the pelvic diaphragm with its fascial coverings

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56
Q

What does levator ani provide?

A

Continual support for the pelvic organs

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57
Q

Describe the contractions of levator ani

A

Tonic contraction

Reflexively contracts further during situations of increased intra-abdominal pressure

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58
Q

What can be a factor in the development of prolapse of the pelvic organs?

A

Weakness of levator ani

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59
Q

What is the nervous supply to levator ani?

A

Nerve to levator ani

S3,4,5 sacral plexus

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60
Q

What nerve supplies the perineal muscles?

A

Pudendal nerve

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61
Q

What is the perineal body?

A

Bundle of collagenous and elastic tissue into which the perineal muscles attach

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62
Q

What is the perineal body important for?

A

Pelvic floor strength

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63
Q

Where is the perineal body located?

A

In perineum, just deep to skin

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64
Q

Where are the Bartholins glands located?

A

Perineum, just lateral to vaginal orifice on both sides

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65
Q

Where does the bed of breast extend from?

A

Ribs 2-6

Lateral border of sternum to mid-axillary line

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66
Q

Where do breasts lie on?

A

Deep fascia covering pec major and serratus anterior

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67
Q

What lies between the fascia and breast?

A

Retromammary space

68
Q

How are breasts attached to skin?

A

Firmly via suspensory ligaments

69
Q

Where does most lymph from the breast drain to?

A

Ipsilateral axillary nodes, then to supraclavicular nodes

70
Q

Where can lymph from inner breast quadrants drain to?

A

Ipsilateral and contralateral lymph nodes

71
Q

Where can lymph from the lower inner breast quadrant drain to?

A

Abdominal lymph nodes

72
Q

What is the axilla?

A

Pyramidal pathway between arm and chest

73
Q

What does the axilla contain?

A

Brachial plexus branches
Axillary artery (& branches) and axillary vein (& tributaries)
Axillary lymph nodes
All embedded in axillary fat

74
Q

What do breast surgeons use to describe the extent of axillary node clearance?

A

‘Levels’ of axillary nodes

75
Q

What are the levels of the axillary lymph nodes?

A

Level I – inferior and lateral to pectoralis minor
Level II – deep to pectoralis minor
Level III – superior and medial to pectoralis minor

76
Q

What is the adnexae?

A

Ovaries and fallopian tubes

77
Q

What nerve fibres are involved in the pelvis?

A

Sympathetic
Parasympathetic
Visceral afferent

78
Q

What nerve fibres are involved in the perineum?

A

Somatic motor

Somatic sensory

79
Q

What are the nerve fibres associated with uterine cramping?

A

Sympa/parasympathetic (hormonal)

80
Q

What are the nerve fibres associated with uterine contraction?

A

Sympa/parasympathetic (hormonal)

81
Q

What are the nerve fibres associated with pelvic floor muscle contraction?

A

Somatic motor

82
Q

What are the nerve fibres associated with pain from adnexae?

A

Visceral afferents

83
Q

What are the nerve fibres associated with pain from uterus?

A

Visceral afferents

84
Q

What are the nerve fibres associated with pain from vagina?

A 
Visceral afferents (pelvic part)
Somatic sensory (perineum)
85
Q

What are the nerve fibres associated with pain from the perineum?

A

Somatic sensory

86
Q

Describe the pain sensation from the superior aspect of pelvic organs/touching the peritoneum

A

Visceral afferents
Run alongside sympathetic fibres
T11-L2
Pain perceived as suprapubic

87
Q

Describe the pain sensation from the inferior aspect of pelvic organs/not touching the peritoneum

A

Visceral afferents
Run alongside parasympathetic fibres
S2,3,4
Pain perceived in S2,S3,S4 dermatome (perineum)

88
Q

Describe the pain sensation from structures crossing from pelvis to perineum e.g. urethra, vagina (above levator ani)

A

Visceral afferents
Parasympathetic
S2,3,4

89
Q

Describe the pain sensation from structures crossing from pelvis to perineum e.g. urethra, vagina (below levator ani)

A

Somatic sensory
Pudendal nerve
S2,3,4-localised pain within perineum

90
Q

At what level does spinal cord become cauda equina?

A

L2 vertebra

91
Q

At what level does the SA space end?

A

S2

92
Q

Is there a likely risk of infection in spinal/epidural anaesthetic?

A

No

93
Q

What does the needle pass through in a spinal anaesthetic?

A 
Supraspinous ligament
Interspinous ligament
Ligamental flavum
Epidural space (fat + veins)
Dura mater
Arachnoid mater
SA space
94
Q

What does the needle pass through in an epidural anaesthetic?

A

Supraspinous ligament
Interspinous ligament
Ligamental flavum
Epidural space (fat + veins)

95
Q

What happens to the sympathetic outflow below L2 level?

A

Sympathetic ganglia receive fibres from L2 level via sympathetic chain
Distribute them via connections with lumbar, sacral and coccygeal spinal nerves

96
Q

What does spinal anaesthetic effect?

A

All spinal nerves and their named nerves (containing sympathetic fibres) below level of injection

97
Q

What does the blockade of sympathetic tone to all arterioles in lower limb result in?

A 
Vasodilation:
skin of lower limbs lookds flushed
Warm lower limbs
Reduced sweating
All signs that spinal anaesthetic is working
98
Q

What must be watched for in spinal anaesthetic?

A

Hypotension

99
Q

What does the pudendal nerve supply?

A

Somatic motor and sensory structures of the perineum

100
Q

Where does the pudendal nerve originate?

A

Branch of sacral plexus : S2,3,4

101
Q

What does a pudendal nerve block do?

A

Anaesthetise majority of perineum

102
Q

What is a pudendal nerve block useful for?

A

Episiotomy incision
Forcepss use
Perineal stitching post delivery

103
Q

Describe the course of the pudendal nerve

A

Exits pelvis via greater sciatic foramen
Passes posterior to sacrospinous ligament
Re-enters pelvis/perineum via lesser sciatic foramen
Travels in pudendal canal (passageway within obturator fascia) within internal pudendal artery and vein, and nerve to obturatory internus
Branches to supply structures of perineum

104
Q

What can be used as a landmark to administer block?

A

Ischial spine

105
Q

What can cause pudendal nerve of sphincter damage during labour?

A

Branches of pudendal nerve can be stretched with resultant stretch of nerve fibres
Fibres within the levator ani (puborectalis) or external anal sphincter muscle could be torn and as a result, the muscle weakened from 1st to 3rd degree
Weakened pelvic floor and faecal incontinence could result

106
Q

What is an episiotomy?

A

Posterolateral (mediolateral) incision

Made into the relatively safe fat filled ischioanal fossa and avoids incision extending into rectum

107
Q

What are the layers of the anterolateral abdominal wall?

A

Skin
Superficial Fascia
Anterior: Rectus Sheath, Rectus Abdominis
Lateral: External oblique, Internal oblique, Transversus Abdominis

108
Q

What are the attachments of the external obliques?

A

Between lower ribs and iliac crest, pubic tubercle and linea alba

109
Q

What is the linea alba?

A

Midline interweaving of aponeuroses of anterolateral abdominal wall muscles

110
Q

The fibres of external obliques run in the same direction as what?

A

External intercostals

111
Q

What are the attachments of the internal obliques?

A

Between lower ribs, thoracolumbar fascia, iliac crest and linea alba

112
Q

The fibres of internal obliques run in the same direction as what?

A

Internal intercostals

113
Q

Where does transversus abdominis attach between?

A

Lower ribs, thoracolumbar fascia, iliac crest and linea alba

114
Q

What do the tendinous intersections of the rectus abdominis do?

A

Divide each rectus abdominis into 3 or 4 smaller muscles to improve mechanical efficiency

115
Q

Where does the linea alba run from?

A

Xiphoid process to the pubic symphysis

116
Q

What is the rectus sheath?

A

Combined aponeuroses of anterolateral abdominal wall muscles surrounding rectus abdominis muscles

117
Q

When undertaking a suprapublic incision, such as in lower segment C-section, what is cut from the anterior and posterior rectus sheath?

A

Anterior rectus sheath only

118
Q

Describe the nerve supply to the anterolateral abdominal wall

A 
Enter from lateral direction
7-11th intercostal nerves: become thoracoabdominal nerves
Subcostal (T12)
Iliohypogastric (L1)
Iliolingual (L1)
119
Q

Where does the nerve supply to the anterolateral abdominal wall travel?

A

In plane between internal oblique and transversus abdominis

120
Q

What is the blood supply to the anterior abdominal wall?

A

Superior epigastric arteries

Inferior epigastric arteries

121
Q

Describe the superior epigastric arteries

A

Continuation of internal thoracic
Emerges at superior aspect of abdo wall
Lies posterior to rectus abdominis

122
Q

Describe the inferior epigastric arteries

A

Branch of external iliac artery
Emerges at inferior aspect of abdo wall
Lies posterior to rectus abdominis

123
Q

What is the blood supply to the lateral abdominal wall?

A

Intercostal and subcostal arteries

124
Q

Describe the intercostal and subcostal arteries

A

Continuations of posterior intercostal arteries

Emerge at lateral aspect

125
Q

How should you aim to minimise traumatic injury to muscle fibres when making an incision?

A

Incise in same direction as muscle fibre

126
Q

When incising muscle, what should be aimed for?

A

Minimise traumatic injury to muscle fibres
Avoid damaging nerves
Avoid interrupting blood supply

127
Q

What is done to the rectus muscles in a LSCS incision?

A

Separated from each other in a lateral direction, moving them toward their nerve supply

128
Q

What layers are cut/moved in an LSCS?

A

Skin and fascia
(anterior) Rectus sheath
Rectus abdominis – separate the muscles laterally
Fascia and peritoneum
Retract bladder (a urinary catheter is usually already inserted)
Uterine wall
Amniotic sac

129
Q

What layers need stitched closed in an LSCS?

A

Uterine wall with visceral peritoneum
Rectus sheath
(Fascial layer if increased BMI)
Skin

130
Q

What layers are opened in a laparotomy?

A

Skin and fascia
Linea alba (a structure rather than a layer)
Peritoneum

131
Q

What layers need stitched closed in a laparotomy?

A

Peritoneum & Linea alba
Fascia (if increased BMI)
Skin

132
Q

What complications can occur in a laparotomy as it is relatively bloodless?

A

Can mean that healing is not as good

Increases the chance of wound complications e.g. dehiscence, incisional hernia

133
Q

What must be avoided if a lateral port is required?

A

Inferior epigastric artery

134
Q

In a laparotomy how can the position of the uterus be manipulated?

A

By grasping the cervix with forceps inserted through the vagina

135
Q

What is the route of the inferior epigastric artery?

A

Branch of external iliac artery
Emerges just medial to the deep inguinal ring- ring located halfway between ASIS and pubic tubercle
Then passes in a superomedial direction posterior to the rectus abdominis

136
Q

What is an abdominal hysterectomy?

A

Removal of the uterus via an incision in the abdominal wall (A)
Often same incision as for LSCS

137
Q

What is a vaginal hysterectomy?

A

Removal of uterus via the vagina

138
Q

How can the ureter be differentiated from the uterine artery in a hysterectomy to avoid damaging it?

A

Ureter passes inferior to artery (water under bridge)

Ureter will vermiculate when touched

139
Q

What is the pelvic floor made up of?

A

Pelvic diaphragm
Muscles of perineal pouches
Perineal membrane

140
Q

What makes up the pelvic diaphragm?

A

Levator Ani

Coccygeus

141
Q

What does levator ani attach?

A

Pubic bones, ischial spines and tendinous arch of levator ani
Perineal body, coccyx and walls of organs in midline

142
Q

What are the 3 parts of levator ani?

A

Puborectalis
Pubococcygeus
Iliococcygeus

143
Q

What innervates levator ani?

A

Pudendal nerve and nerve to levator ani

144
Q

Where does the deep perineal pouch lie?

A

Below the fascia covering the inferior aspect of the pelvic diaphragm
Above the perineal membrane

145
Q

What is contained within the deep perineal pouch?

A

Part of urethra (and vagina in females)
Bulbourethral glands in males
NVB for penis/clitoris
Extensions of ischioanal fat pads and muscles

146
Q

Where does the perineal membrane attach?

A

Laterally to the sides of the pubic arch, closing the urogenital triangle

147
Q

Where is the superficial perineal pouch in males?

A

Below the perineal membrane

148
Q

What is contained within the superficial perineal pouch in males?

A

Root of penis:
-Bulb- corpus spongiosum, crura-corpus cavernosum
-Associated muscles- bulbospongiosus and ischiocavernosus
Proximal spongy urethra
Superficial transverse perineal muscle
Branches of internal pudendal vessels and pudendal nerve

149
Q

What is contained within the superficial perineal pouch in females?

A

Female erectile tissue and associated muscle:
-Clitoris and crura-corpus cavernosum
-Bulbs of vestibule-paired
-Associated muscles- bulbospongiosus and ischiocavernosus
Greater vestibular glands
Superficial transverse perineal muscle
Branches of internal pudendal vessels and pudendal nerve

150
Q

What are the functions of the pelvic floor?

A

Support to pelvic organs- normally tonically contracted, actively contracts in coughing etc
Helps maintain continence:
-urinary (external urethral sphincter, compressor urethrae, levator ani)
-faecal (tonic contraction of puborectalis bends anorectum anteriorly, active contraction maintains continence after rectal filling)

151
Q

What can cause injury to pelvic floor?

A 
Pregnancy
Childbirth
Chronic constipation
Obesity
Heavy lifting
Chronic cough or sneeze
Previous injury to pelvic/pelvic floor
Menopause
152
Q

What does continence depend on?

A

Urinary bladder neck support
External urethral sphincter
Smooth muscle in urethral wall

153
Q

Describe vaginal prolapse

A

Herniation of urethra, bladder, rectum or rectouterine pouch through supporting fascia
Presents as lump in vaginal wall
Can be urethro/cysto/recto/entero-cele

154
Q

Describe uterine prolapse

A 
Descent of uterus
1st, 2nd, 3rd degree
Dragging sensation
Feeling of lump
Urinary incontinence
155
Q

Describe sacrospinous fixation

A 
Sutures placed in sacrospinous ligament
Just medial to the ischial spine
To repair cervical/vault descent
Performed vaginally
Risk of injury to pudendal NVB and sciatic nerve
156
Q

Describe incontinence surgery

A 
Trans-obturator approach
Mesh through obturator canal
Space in obturator foramen for passage of obturator NVB
Create a sling around the urethra
Incisions through vagina & groin
157
Q

Where do the majority of arteries of pelvis and perineum arise from, and what are the exceptions?

A

From internal iliac artery
Exceptions:
Gonadal artery- L2 abdominal aorta
Superior rectal artery- continuation of inferior mesenteric

158
Q

What is the medial umbilical fold a remnant of?

A

Umbilical artery

159
Q

Where are most branches of the arteries in the male perineum from, and what is the exception?

A

Internal pudendal

Anterior scrotal artery is exception as comes from external iliac

160
Q

Where do anastomoses occur in the female reproductive system?

A

Between uterine and ovarian artery, and between uterine and vaginal artery

161
Q

Where do most pelvic and perineal veins drain to?

A

Internal iliac vein

Some via superior rectal into hepatic portal system, some via lateral sacral veins into internal vertebral venous plexus

162
Q

Why does ureter damage occur more on the left than the right?

A

As the right is constant and usually crosses external iliac, whereas the left is more medial and crosses common iliac
51% of ureter damage occurs lateral to cervix during uterine artery division

163
Q

What is the lymphatic drainage of the superior pelvic viscera?

A

External iliac nodes

Common iliac, aortic, thoracic duct, venous system

164
Q

What is the lymphatic drainage of the inferior pelvic viscera?

A

Deep perineum
Internal iliac nodes
Common iliac, aortic, thoracic duct, venous system

165
Q

What is the lymphatic drainage of the superficial perineum?

A

Superficial inguinal lymph nodes

166
Q

What is the gonadal lymphatic drainage?

A

Lumbar (aortic/caval) nodes

Reproduction (40 decks)

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