Anatomy Flashcards
What does the bony pelvis consist of?
2 hip bones
Saccrum
Coccyx
Outline the pelvic inlet
Sacral promontory
Ilium
Superior pubic ramus
Pubic symphysis
Outline the pelvic outlet
Pubic symphysis Ischiopubic ramus Ischial tuberosities Sacrotuberous ligaments Coccyx
List palpable landmarks of the pelvis
Ischial tuberosity Iliac crest ASIS Pubic tubercle PSIS Pubic symphysis Coccyx Sacrum
Where are the ischial spines palpable?
4 and 8 o’clock on vaginal exam
Where does the inguinal ligament attach?
Between the ASIS and pubic tubercle
What are the joints of the pelvis?
Sacroiliac joint (x2) Hip joint (x2) Pubic symphysis
What are the 2 ligaments of the pelvis?
Sacrotuberous
Sacrospinous
Where does the sacrotuberous ligament attach?
Sacrum to ischial tuberosity
Where does the sacrospinous ligament attach?
Sacrum to the ischial spine
What passes through the obturator foramen?
Obturator nerve and vessels
Trauma to bony pelvis can damage what?
Common iliac artery Common iliac vein Sacral nerves/plexus Uterus Bladder Rectum
Is the AP and transverse diameters of pelvis larger in males or females?
Females
Is the subpublic angle and pelvic arch wider in males or females?
Females
Is the pelvic cavity shallower in males or females?
Females
Is the greater sciatic notch bigger in males or females?
Females
Is the sacrum and coccyx more curved in males or females?
Males
When does the anterior Fontanelle close over?
9-18 months
When does the posterior Fontanelle close over?
3-6 months
What is the ability of the bones to move over each other to allow delivery of foetal head called?
Moulding
What pouches does the peritoneum form?
Vesico-uterine
Recto-uterine (pouch of Douglas)
How do you get rid of fluid collected in the pouch of douglas?
Drainage by needle passed through posterior fornix of vagina
Are the broad ligaments of the uterus 1, 2 or 2 layers of peritoneum?
2
Where does the broad ligaments extend?
Between uterus and lateral walls and floor of pelvis
What does the broad ligament contain?
Uterine tubes
Proximal part of round ligament
The round ligament is an embryological remnant of what?
Gabernaculum
What ring dos the round ligament pass through?
Deep inguinal ligament to attach to superficial tissue of female peritoneum
What are the 3 layers of the body of the uterus?
Perimetrium
Myometrium
Endometrium
What are the most common positions of the uterus?
Anteverted
Anteflexed
What is the position of an anteverted uterus?
Uterus tipped anteriorly in relation to axis of vagina
What is the position of an anteflexed uterus?
Uterus tipped anteriorly in relation to axis of the cervix
What are other variations of position of the uterus?
Retroverted (tipped posteriorly in relation to axis of vagina)
Retroflexed (tipped posteriorly in relation to axis of cervix)
Where does fertilisation normally take place?
Ampulla of uterine tubes
What is a bilateral salpingo-oophrectomy?
Removal of both uterine tubes and ovaries
What is a unilateral salpingectomy?
Removal of one uterine tube
What test can be done to check the patency of ends of uterine tubes?
Hysterosalpingogram - HSG
Is the vagina an open or closed tube?
Closed apart from superiorly where cervix holds it open- fornix
Nerve supply of the levator ani muscle?
Nerve to levator ani (S3,4,5)
Nerve supply to perineal muscles?
Pudendal nerve
Over which ribs does the female breast extend?
2-6
What muscles does the female recast lie superiorly to?
Pec major
Serratus anterior
Where is the retromammary space?
Between fascia and the breast
What are the 4 quadrants of the breast?
Upper outer
Upper inner
Lower outer
Lower inner
Where does majority of breast lymph drain to?
Ipsilateral axillary lymph nodes then supraclavicular lymph nodes
Where an lymph from inner breast drain to?
Parasternal lymph nodes
Where can lymph from lower inner breast drain to?
Abdominal lymph nodes
Level 1 axillary node clearance means?
Inferior and lateral to pec minor
Level II axillary node clearance means?
Deep to pec minor
Level III axillary node clearance means?
Superior and medial to pec minor
Pain from superior aspect of pelvic organs is felt where?
Suprapubic
What fibres in charge of pain sensation in superior aspect of pelvic organs?
Visceral afferents
Visceral afferents supplying pain sensation to superior pelvic organs follow what path and enter spinal cord where?
Alongside sympathetic fibres
Enter between T11-L2
What fibres supply pain sensation to the inferior aspect of pelvic organs?
Visceral afferents
What path do the visceral afferents supplying pain sensation to inferior aspect of pelvic organs follow? And where in spinal cord do they enter?
Alongside parasympathetic fibres
S2,3,4
Where is pain perceived from inferior aspect of pelvic organs?
S2,3,4 dermatomes
Structures below levator ani are supplied by which pain fibres?
Somatic sensory and pudendal nerve
Where is pain felt by structures in perineum, below levator ani?
Localised pain within perineum
Where does spinal cord become cauda equina?
L2
Where does the subarachnoid space end?
S2
What spinal levels is anaesthetic injected at?
L3-4
In a spinal anaesthetic, what does the need have to pass through before getting to subarachnoid space?
Supraspinous ligament Interspinous ligament Ligamentum flavum Epidural space Dura mater Arachnoid matter Subarachnoid space (CSF) - hear little pop
In an epidural anaesthetic, what does the needle have to pass through before reaching the epidural space?
Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Epidural space
What does blockage or sympathetic tone to arterioles in lower limb cause?
Vasodilation
What suggests a spinal anaesthetic is working?
Skin of lower limbs looks flushed
Warm lower limbs
Reduced sweating
What does a pudendal nerve block anaesthetise?
Majority of perineum
What is a pudendal nerve block used for?
Episiotomy incision
Forceps use
Perineal stitching post-delivery
Describe the course of the pudendal nerve
Exits pelvis via greater sciatic foramen
Passes posterior to sacrospinous ligament
Enters pelvis/perineum via lesser sciatic foramen
Travels in pudendal canal
Branches to supply structures of perineum
Where is an episiotomy incision made?
Posterolateral (or mediolateral but less common) in ischioanal fossa
Where do the external obliques attach?
Lower ribs (5-12)
Iliac crest
Pubic tubercle
Linea alba
In what direction do external oblique fibres run?
Same as external intercostals - hands in pockets
Where do the internal obliques attach?
Lower ribs
Thoracolumbar fascia
Iliac crest
Lines alba
In what direction do the internal oblique fibres run?
Same direction as internal intercostals
Perpendicular to external obliques
Where does the transversus abdominis attach?
Lower ribs
Thoracolumbar fascia
Iliac crest
Linea alba
What is the recluse abdominis made up of?
3 or 4 smaller muscles to improve ,each animal efficiency
Where does the Linea alba extend?
From xiphoid process to pubis symphysis
What layer does the refutes sheath lie deep to?
Superficial fascia
Nerve supply to the anterolateral abdominal wall?
7th-11th intercostal nerves becoming the thoracoabdominal nerves
Blood supply to the anterior abdominal wall?
Superior epigastric arteries and inferior epigastric arteries
What is the inferior epigastric artery a branch of?
The external iliac artery
What is the superior epigastric artery a continuation of?
The internal thoracic artery
Blood supply of the lateral abdominal wall?
Intercostal and subcostal arteries
What is an LSCS?
Lower segment Caesarean section
Layers needing opening when doing LSCS?
Skin and fascia Anterior rectus sheath Rectus abdominis - pulled apart not cut Fascia and peritoneum Retract bladder Uterine wall Amniotic sac
What is a laparotomy?
A midline incision
Does a laparotomy heal better /worse
Not a good because quite bloodless so increased chance of wound complications
What is laparoscopy?
Key-whole
Anatomically where is inferior epigastric artery?
Emerges medial to deep inguinal ring - half way between ASIS and pubic tubercle
Passes in superomedial direction posterior to rectus abdominis
What is an abdominal hysterectomy
Removal of uterus via incision in abdo wall
What is a vaginal hysterectomy?
Removal of uterus via vagina
Where is ureter in relation to uterine artery?
Ureter passes inferior to artery
What 3 layers make up the pelvic floor?
Pelvic diaphragm
Muscles of perineal pouches
Perineal membrane
What muscle groups does the pelvic diaphragm contain?
Levator ani
Coccygeus
What is the anterior gap in the pelvic diaphragm called and what passes through it?
Urogenital hiatus
Urethra and vagina
What does the levator ani attach to?
Pubic bones
Ischial spines
Tendinous arch of levator ani
What 3 parts make up the levator ani?
Puborectalis
Pubococcygeus
Iliococcygeus
The levator ani must relax/contract to allow urination and defaecation?
Relax
Innervation of levator ani?
Pudendal nerve and nerve to levator ani
Where is the deep perineal pouch?
Below fascia covering inferior aspect of pelvic diaphragm
Above perineal membrane
What does the deep perineal pouch contain?
Part of urethra Vagina in females Bulbourethral glands in male NVB for penis/clitoris Extensions of ischioanal fat pads and muscles
Where is the perineal membrane?
Superficial to the deep perineal pouch
Where is the superficial perineal pouch?
Below the perineal membrane
In males, what does the superficial perineal pouch contain?
Root of penis - bulb (corpus spongiosum) , crura (corpus cavernosum)
Bulbospongiosus and ischiocavernosus
Proximal spongy urethra
Superficial transverse perineal muscle
Branches of internal pudendal vessels and pudendal nerve
In females, what does the superficial perineal pouch contain?
Female erectile tissue - clitoris and crura ( corpus cavernosum), bulbs of vestibule
Bulbospongiosus and ischiocavernosus
Greater vestibular glands
Superficial transverse perineal muscle
Branches of internal pudendal vessels and pudendal nerve
Lists ways of injury to pelvic floor
Pregnancy Childbirth - stretching or tearing/ pudendal nerve damage Chronic constipation Obesity Heavy lifting Chronic cough or sneeze Previous injury to pelvis or pelvic floor Menopause
Is prolapse common or not?
Common
What happens in vaginal prolapse?
Herniation of urethra, bladder, rectum or recto uterine pouch through supporting fascia
How does a vaginal prolapse present?
Lump in vaginal wall
How does a uterine prolapse present?
Dragging sensation or feeling of a lump
What is the treatment of a prolapse?
Sacrospinous fixation
Incontinence surgery
Where does the gonadal artery arise from?
L2 abdominal aorta
Where does the superior rectal artery arise from?
Continuation of the inferior mesenteric artery
What is the media umbilical ligament a remnant of?
Umbilical artery - connected internal iliac to placenta through umbilical cord
What does the internal pudendal nerve terminate as?
Dorsal artery
Deep artery of penis (only in males)
Where does the anterior scrotal artery come from?
External iliac artery
Where does venous drainage of lateral pelvic wall occur to?
Mainly into internal iliac vein
Some via superior rectal into hepatic portal system
Some via lateral sacral veins into internal vertebral venous plexus
Where does superior pelvic viscera lymph drain to?
External iliac nodes
Where does inferior pelvic viscera lymph drain to ?
Deep perineum
Internal iliac nodes
Where does superficial perineum lymph drain to?
Superficial inguinal nodes
