Anatomy Flashcards
sacrotuberous ligament
sacrum and interest on ischial tuberosity
sacrospinous ligament
originates on sacrum and inserts on ischial spine
muscles of pelvic diaphragm
levator ani
coccygeus
levator ani muscles
puborectalis
pubococcygeus
iliococcygeus
puborectalis
origin: superior pubic ramus
insertion: anococcygeal ligament
innervation: S4, inferior anal n
pubococcygeus
origin: pubis lateral to puborectalis
insertion: anococygeal ligament, coccyx
innervation: S4, inferior anal n
iliococcygeus
origin: internal obturator fascial of levator ani (tendinous arch)
insertion: anococcygeal ligament, coccyx
innervation: S4, inferior anal n
coccygeus
origin: sacrum
insertion: ischial spine
innervation: S4-5
muscles of the pelvic wall
piriformis
obturator internus
piriformis
origin: sacrum
insertion: greater trochanter of femur
innervation: S1-2
external rotation and abduction of flexed hip
obturator internus
origin: obturator membrane
insertion: medial greater trochanter of femur
innervation: L5-S1
external rotation and abduction of flexed hip
levator (genital) hiatus
a gap between puborecalis muscles allowing for passage of urethra vagina and rectum into perineum
membranous pelvic fascia
visceral
parietal
visceral pelvic fascia
surrounds organs
parietal pelvic fascia
lines inner surface of muscles of pelvic walls and floor
continuous with transversals fascia and psoas fascia
tendinous arch of pelvic fascia
where pelvic viscera pierce the pelvic diaphragm the parietal and visceral layer merge
runs from pubis to sacrum
endopelvic fascia
loose CT matrix that fills subperiotoneal space between visceral and parietal layers of membranous fascia
allows for dissension of pelvic organs
superior vesical a
in lateral ligament of bladder
uterine a
in cardinal ligament
comes off internal iliac a
vesicouterine pouch
between bladder and uterus
rectouterine pouch of douglas
between uterus and rectum
lowest point of female peritoneal cavity
rectopubic space
between pubic symphsis and bladder
rectorectal space
between rectum and sacrum
rectovaginal septum
separates the rectum and vagina
trace R common iliac
R internal iliac –> R umbilical–> R superior vesical
R ovarian artery and v
in suspensory ligament of ovary off of abdominal aorta at L2
R uterine artery
branch of R internal iliac a
right vaginal a
branch of R internal iliac a
inferior vescial a
arises with middle rectal a off of internal iliac a
anterior division of internal iliac a gives rise to
umbilical a ---> superior vesical a uterine a vaginal a middle rectal internal pudendal
internal pudendal a gives off
inferior rectal - external anal sphincter and skin around anus
perineal a
clitoral a
superior rectal a
branch of inferior mesenteric a
supplies upper rectum and anal canal and anastomoses with middle and inferior rectal a in pelvis and perineum
ovarian v
drain directly into inferior vena cava on R
drain into renal vein ion L
superior rectal v
drains into hepatic portal system through inferior mesenteric v
obturator n
L2-4
doesn’t innervate structures of pelvis but can be injured during surgery
sacral plexus
L4-S4
exit via greater sciatic foramen where they innervate structures in perineum, gluteal region and lower limb
pudendal n
S2-4
mixed sensory and motor n
branches: inferior retal, perienal n, clitoral n
uterovaginal rectal plexus
from inferior hypogastric plexus
ovarian ligament
connects ovary to supra lateral aspect of uterus
suspensory ligament of ovary
carries ovarian vessels and n
mesovarium
suspends ovary from posterior par of broad ligament
lymphatic vessels of ovary
superiorly to the lateral attic nodes
innervation of ovary
ovarian plexus (follows ovarian vessels) and pelvic plexus (follows pelvic vessels)
parts of fallopian tubes
intramural (most medial)
isthmus
ampulla
infundibulum (most lateral)
fallopian tubes supported by
mesosalpinx
vessels to fallopian tubes
anastomosing ovarian and uterine arteries
lymph vessels of fallopian tubes
follow ovarian v to lateral aortic nodes
innervation of fallopian tubes
ovarian and uterine plexuses
ruptured ectopic pregnancy on R side can be misdiagnosed as
ruptured appendix
bicornate uterus
failure of fusion of paramesonephic ducts
higher chance of recurrent pregnancy loss , preterm birth, and malpresentation of baby
broad ligament of uterus
double fold of peritoneum that extends laterally from each side of uterus to sidewalls of pelvis
mesosalpinx
mesovarium
mesometrium
round ligaments of uterus
originate near fundus pass through deep inguinal rings through inguinal canal insert on labial majora
cardinal (transverse cervical) ligaments
connect uterine cervix to pelvic side wall
base of broad ligament
transmit uterine vessels
uterosacral ligaments
help maintain anteverted position of uterus
uterine a
traverse the cardinal ligament and anastomoses superior with ovarian a and inferiorly with vaginal a
uterine v
drain into internal iliac v
lymphatic of uterine fundus
drains to para aortic nodes via ovarian v
uterine body lymphatics
drains to external iliac nodes via broad ligament
cervix lymphatics
to internal iliac and sacral nodes via cardinal and uterosacral ligaments
innervation of uterus
uterovaginal n plexuses from inferior hypogastric plexuses
anterior vaginal fornix
short
lies against posterior wall of bladder
posterior vaginal fornix
longer in contact with rectouterine pouch
vaginal a
branch of internal iliac a
vaginal v
branches of internal iliac v
superior part of vaginal lymphatics
external or internal iliac nodes
inferior part of vagina lymphatics
sacral and common iliac nodes
innervation of superior 3/4 vagina
uterovaginal plexus from inferior hypogastric plexus
lowest vaginal segment innervation
deep perineal branch of pudendal nerve (branch of sacral plexus) somatic innervated
only part of vaginal sensitive to touch
culdocentesis
peritoneal fluid is extracted from rectouterine pouch by needle aspiration through posterior fornix of vagina
PID
ureters
pass inferior to uterine arteries within cardinal ligaments
blood supply to ureters
uterine a
innervation of pelvic ureter
inferior hypogastric plexus
bladder is only covered by peritoneum on its
superior surface
parts of bladder
apex
fundus
body
neck
median umbilical ligament
apex of bladder to umbilicus
pubovesical ligaments
neck of the bladder to pubis
lateral vesical ligaments
connection neck of bladder to lateral pelvic walls
bladder holds up to
600-800ml
superior vesical a and vaginal a supply
the bladder
vesical venous plexuses
drains to internal iliac v
innervation of bladder
inferior hypogastric plexus
urethra
lies anterior to vagina
arteries that supply urethra
branches of pudendal a, inferior vesical a , vaginal a
lymphatic drainage of urethra
internal iliac nodes
innervation to urethra
vesical nerve plexus
rectum lies on ____ ligament of pelvic floor
anococcygeal ligament
rectum has no
mesentery
rectum usually starts at
S3
rectum terminates at
analrectum junction
rectal ampulla
passes through pelvic diaphragm
superior rectal a
terminal branch of inferior mesenteric a
upper rectum
right and l middle rectal a
branches of internal iliac
supply lower rectum
external hemorrhoids
thromboses veins of external venous plexus
commonly associated with constipation and pregnancy
below dentate line and are covered by skin
somatically innervated- painful
internal hemorrhoids
dilated veins of internal recal plexus
due to breakdown of muscularis layer and can become ulcerated
above dentate line
viscerally innervated - painlesss
perineum
urogenital triangle and anal triangle
perineal membrane
though fibrous sheet
extends anteriorly almost o pubic symphysis and poster to ischial tuberosities
separates urogenital triangle into deep perineal and superficial perineal paces
superficial perineal space contains
bulbocavernosus, ischiocavernosius, superficial transverse perineal m and deep perineal branches of internal pudendal vessels and pudendal n, clitoris, vestibular bulb, and greater vestibular glands
superficial perineal space
potential space bounded by perineal membrane and superficial perineal fascia (Colle’s fascia- extension of scrap’s fascia in abdomen)
deep perineal space
bounded by perineal membrane and pelvic diaphragm
deep perineal space contains
urethera, inferior part of external urethral sphincter ischoanal fat pads, nv bundle to vlitoris , urethrovaginal sphincter, compressor urethra, smooth muscle associated with perineal body
perineal body
formed by converging fibers of levator ani, deep transverse perineal , bulbospongiouss, and external anala sphincter
innervation of perineum
pudendal n
blood supply to perineum
perineal branches of internal pudendal a (branch of internal iliac)
episiotomy
incision through posterior vaginal orifice into perineal body
prevent damage to perineal m
clitoris is made of
corpus cavernousa
vestibular bulbs
bulbospongiousus mm
bartholin glands
under the posterior end of vestibular bulbs
external pudendal art
supplies skin over mons pubis and labia majora
perineal a supplies
perineal m and labia minora
dorsal clitoral a
supplies glans of clitoris
deep clitoral a
corpus cavernosum of clitoris