Anatomy Flashcards
What makes up the anterior border of the pelvic outlet
Inferior margin of pubic symphysis
What makes up the posterolateral border of the pelvic outlet
Sacrotuberous ligaments
What makes up the posterior border of the pelvic outlet
Tip of coccyx
Which part of the pelvis is termed the true pelvis
Below pelvic brim
Which part of the pelvis is termed the false pelvis
Above pelvic brim
Describe the subpubic angle in M vs F
F = Obtuse >90 M = acute <90
What type of the joint is the sacroiliac joint
Synovial plane
What type of joint is the pubic symphysis
Secondary cartilaginous
Which muscle lines the lateral wall of the pelvis
Obturator internus
Which muscle lines the posterior wall of the pelvis?
Piriformis
Which nerve network lies anterior to the piriformis?
Sacral plexus
Name the levator ani muscles
Puborectalis
Pubococcygeus
Iliococcygeus
Which muscle other than levator ani makes up the pelvic diaphragm
Coccygeus
what are the perineal and anococcygeal bodies?
Points where muscles of pelvic diaphragm meet
Give 2 functions of pelvic diaphragm/floor
support of pelvic and abdominal contents
Urinary and fecal continence
What is the innervation of the pelvic diaphragm/floor
Pudendal nerve
S2-4
What is a cystocele
When the rbladder bulges into the anterior vagina
What is a rectocele
When the rectum bulges into the posterior vaignal wall
Why might an episiotomy minimise long term damage
Prevent tearing of perineal body which struggles to heal
Why is a mediolateral episiotomy preferable to a midline episiotomy
Avoids the perineal body and anal sphincters
What might be palpated on a male PR examination
Prostate
What might be palpated in a female on PR examination
Tampon
Which organ does the superior and inferior vesical a. supply
bladder
seminal gland
prostate
What does the uterine artery supply
uterus
What does the gonadal a. supply?
M= testes F = ovaries
What is the middle and inferior rectal a. a branch of?
Internal iliac artery
What does the vaginal a. supply?
Vagina
What is the vaginal a. a branch of?
Uterine artery
What is the uterine artery a branch of
Internal iliac a.
What does the obturator a. supply
Adductor thigh muscles
What is the obturator a. a branch of?
Internal iliac a.
Where does the ilioinguinal nerve originate from?
L1
Where does the ilioinguinal nerve enter the inguinal canal
Superficial inguinal ring
Where does the genitofemoral nerve originate from
L1-L2
Where does the genitofemoral nerve enter the inguinal canal
Deep inguinal ring
What does the ilioinguinal nerve supply
Skin at the root of the penis in M
And labia in F
Where does the pudendal nerve originate from
Sacral plexus
What is the internal pudendal a. a branch of?
Internal iliac a.
From which segmental levels does the pudendal nerve arise
S2-S4
Name some of the male reproductive organs
Testis Vas deference Seminal glands Prostate Epididymis Bulbourethral glands
Which part of the rectum drains into the portal circulation
Upper 1/3
Which part of the rectum drains into the systemic circulation
Lower 2/3
Where does the vas deferens originate from?
Epididymis
Which structure does the vas deferens cross as it enters the pelvis?
External iliac vessels
Where does the vas deferens terminate?
Joining the duct of the seminal gland to form the ejaculatory duct
What is the prostate gland fused to inferior part of?
Bladder
What does the prostate gland surround?
The prostatic urethra
Why might an enlarge prostate cause retention of urine?
It can compress the urethra preventing the outflow or urine
Convoluted tubules sectioned in various planes
4-8 layers of cells
Spermatozoa in the lumen
Leydig cells in the interstitial spaces between tubules
Which histology?
Testis
Serous aveloi with infolding epithelium
Trabeculae of muscular stroma
Amorphous eosinophilic masses, called corpora amylacea, in the alveoli in older men
Which histology?
Prostate
No sperms in the lumen
Highly recessed and irregular lumen forming crypts and cavities giving a honey-combed appearences
Well developed muscular externa
Which histology?
Seminal Vesicle
Lumen Stellate in shape
A thick walled muscular tube
Epithelial lining and its supporting lamina propria are thrown into longitudinal folds
which histology??
Vas deferens
What are the main contents of the spermatic cord
Vas deferens
Arteries
Nerves
What is the tough outer fibrous layer of the testis called
Tunica albuginea
What is the normal position of the uterus?
Anteflexed
Anteverted
At any surgical management of miscarriage why might it be important to know prior to instrumentation of the uterine cavity whether the uterus is anteverted or retroverted?
To minimise risk of perforation of the uterus with insturmentation
What is a hydrocele?
Accumulation of fluid arounds the testis
What is a haematocele?
Accumulation of blood around the testis
At which vertebral level does the testicular arteries arise from the AA
L1/L2
What is the drainage of the fundus and upper uterine body?
Pre-aortic group of lymph nodes
What is the lymphatic drainage of the cervix and upper vagina?
Internal iliac and sacral LN
Into which vein does the right testicular vein drain
Inferior vena cava
Into which vein does the left testicular vein drain
Left renal vein
When does the placenta separate from the uterine wall?
3rd stage labour
What structures are included in the male perineum?
1) External genitalia (urethra, scrotum and penis)
2) perineal muscles
3) Anal canal
What structures are included in the female perineum?
1) Female external genitalia 2) Perineal muscles
3) Anal canal
What is the innervation of external anal sphincter?
Branch of pudendal nerve/ inferior anal nerve
What is the main action of the external anal sphincter
Maintain fecal continence
Main action of external urethral sphincter
Compress urethra to maintain urinary continence
Is the external urethral sphincter voluntary or involuntary?
Voluntary
Is the internal urethral sphincter voluntary or involuntary?
Involuntary
What can happen if the prostate in elderly men becomes enlarged
Leads to BPH Can cause urinary symptoms of prostate symptoms E.g trouble initiating stream Poor flow Terminal dribbling Or urinary retention
What are the fornices of the vagina?
Recesses formed between the margin of the cervix and the vaginal wall
What are the 4 parts of the uterine tube
Isthmus
Ampulla
Infindibulum
Fimbriae
Which ligament goes from the uterus to the ovary?
Ovarian ligament
Which ligament goes from the ovary to the lateral pelvic wall
Broad ligament
At which vertebral level do the gonadal arteries originate?
L2
Into which vein does the left gonadal vein drain?
Left renal vein
Into which vein does the right gonadal vein drain into?
Inferior vena cava
List 4 functions of the placenta
Gaseous exchange Secrete hormones that are essential for pregnancy (e.g HCG, oestrogen) Supply nutrition Remove babies waste Supplies immunology
What is the perineal body
Irregular fibromuscular mass
Located at junction of urogenital and anal triangles
Acts as a point of attachment for muscles fibres from the pelvic floor and perineum
Which muscles converge towards the perineal body
Bulbospongiosus
Superficial and deep transverse perineal muscles
External anal sphincter
what are the 3 parts of the male urethra
Prostatic
Membranous
Spongy
What are the 2 surfaces of the placenta?
Maternal
Fetal
What is the major contentof the ischio-anal(rectal) fossae
Fat
What is the widest part of the male urethra
Prostatic urethra
What is the narrowest part of the male urethra
Membranous urethra
Which 5 veins drain pelvic structures
Internal iliac veins Superior rectal veins Medial sacral veins Gonadal veins Internal vertebral plexus
What does the pudendal nerve innervate?
The skin and muscles of the perineum
Describe the greater pelvis in a female
Shallow
Describe the greater pelvis in a male
Deep
Describe the lesser pelvis in a female
Wide and shallow
Describe the lesser pelvis in a male
Narrow and deep
Describe the pelvic inlet in a male
Heart shaped
Describe the pelvic inlet in a female
Oval and round
Describe the pelvic outlet in a male
Comparatively small
Describe the pelvic outlet in a female
Comparatively large
Describe the obturator foramen in a male
Round
Describe the obturator foramen in a female
Oval
Describe the acetabulum in a male
Large
Describe the acetabulum in a male
Small
What is the origin of the superior and inferior vesical arteries
Internal iliac artery
What is the origin of the uterine artery
Internal iliac a.
What is the origin of the gonadal arteries
Abdominal aorta
L2
What is the origin of the superior rectal artery
Continuation of inferior mesenteric artery
What does the middle and inferior rectal artery supply
Rectum
What is the origin of the internal pudendal artery
Internal iliac artery
Why might haemorrhoids be associated with cirrhosis of the liver
Cirrhosis
Leads to portal hypertension and back up of the system
If upper 1/3 drain into portal circulation backs up in the rectum as haemorrhoids
With which venous plexus does the prostatic venous plexus communicate with on its posterior side?
Internal vertebral venous plexus
What is the clinical significant of the prostatic venous plexus
Prostatic carcinoma commonly spreads via
internal vertebral venous plexus to vertebral bodies
Causing skeletal metastases
What structures in the male are supplied by the genital branch of genitofemoral nerve
Sensory: Anterior scrotum
Motor: Cremasteric muscle
Why is injury to the pelvic floor common?
Due to it weak attachments
After rectal surgery why are some men unable to ejaculate
Due to damage of sympathetic fibres
Which sympathetic fibres supply the vas deferens seminal vesicles, prostate and epididymis in males?
Sympathetic fibres from L1,L2
Via hypogastris plexus
Which sympathetic fibres supply the female genital tract?
Pelvic and ovarian plexuses
Which parasympathetic fibres innervate erectile tissues in both male and female
Parasympathetic fibres from S2,3,4 via hypogastric plexus
Which parasympathetic fibres supply the female genital tract?
Sympathetic fibres from pelvic splanchnic nerve (S2,3,4)
What are the 2 layers of the tunica vaginalis
Visceral
Parietal
What structures do the testicular arteries cross near the pelvic brim
Genitofemoral n.
Ureter
What is the term used for the 8-12 anastomosing veins associated with the testis?
Pampiniform Plexus
What is the function of testicular anastomosing veins?
To regulate temperature (when meeting arterial blood) to drain testes
What is a varicocele
Varicose veins of the testis
Engorgement and dilatation of testicular veins
What secretions are produced by the prostate
Proteolytic enzyme secretions
What secretions are produced by the bulbourethral glands?
Contribute to final semen volume
Produce lubricating mucous secretion
Which parasympathetic fibres supply the female genital tract?
Sympathetic fibres from pelvic splanchnic nerve (S2,3,4)
What is the significance of testis hanging out with the body
Decreases temperature
which is optimum for sperm production
What are the main contents of the spermatic cord
Bas deferens
Blood vessels
Genital branch of genito-femoral nerve
Which 2 lymph nodes receive lymph from the testis?
Lumbar LN
Para-aortic LN
What is the lymphatic drainage of the seminal vesicles
External and internal iliac LN
What is the lymphatic drainage of the scrotum?
Superficial inguinal LN
What is the lymphatic drainage of the penis?
Skin -> superficial inguinal
Deep structures -> internal iliac
Through which vaginal fornix can you access the rectouterine pouch/pouch of douglas?
Posterior fornix
Apart from pelvic fascia what other structures in the pelvis is also an important support of the uterus
Pelvic diphragm
Which part of the uterine tube is the longest and widest?
Ampulla
What are the 2 surfaces of the placenta?
Fetal
Maternal
Lymph from the labia and the distal part of the vagina drain into which group of lymph nodes?
Superficial inguinal
Which group of LN receives lymph from the ovary?
Para-aortic
Remember testes drains into para-aortic
Gonads - para-aortic
What is the lymphatic drainage of the most part of uterine body?
External iliac
What is the lymphatic drainage of the lower vagina?
Superficial inguinal
From which ribs vertically do the breasts extend from and to?
2nd-6th
Horizontally where do the breasts extend from and to?
Lateral border of sternum to mid-axillary line
Which 3 muscles are the breasts related to on their deep surface?
Pectoralis major
Serratus anterior
External oblique
What is the function of umbilical arteries in the fetal circulation
Carried deoxygenated and nutrient depleted blood form the fetus to the placenta
What is the function of umbilical veins in the fetal circulation
Carries oxygentated and nutrient rich blood from the placenta to the fetus
Which umbilical vein persists after birth
Left umbilical vein
A thin sheet of deep fascia stretches between right and left sides of the pubic arch, below the pubic symphysis.
What is the name given to this fascia?
Perineal membrane
Which 2 lymph nodes receive lymph from the testis?
Lumbar LN
Para-aortic LN
In females what does the ovarian artery descend within?
The suspensory ligaments to supply the ovaries via the broad ligament
From which surface of the placenta does the umbilical cord attach to?
Fetal surface
Innervation of external anal sphincter
Branch of pudendal
Main action of external anal sphincter
Maintains fecal continence
Innervation of bulbospongiosus
Perineal nerve
Branch of pudendal
Action of bulbospongiosus
Males - removes residual urine from urethra, pulsatile emission of semen during ejaculation
Female: Constricts vaginal orifice, contributes to clitoral erection and contractions of orgasm
Innervation of ischiocaveronsus
Perineal branch of pudendal nerve
What is the function of ischiocavernosis
Maintains erection of clitoris or penis
Innervation of superficial transverse perineal muscle
Perineal nerve branch of pudendal nerve
Action of superficial and deep perineal muscles?
Fixation of perineal body
Innervation of ischiocaveronsus
Perineal nerve branch of pudendal nerve
Action of superficial and deep perineal muscles?
Fixation of perineal body
Innervation of deep transverse perineal muscle
Pudendal nerve
Innervation of external urethral sphincter
Inferior anal nerve
Branch of pudendal nerve (S2-S4)
Action of external urethral sphincter
Compress urethra to maintain urinary continence
what are the contents of the pudendal canal?
Pudendal nerve
Internal pudendal a.
Internal pudendal v.
Which nerve passes through the lesser sciatic formamen
Pudendal Nerve (S2-S4)
what is the areola
Area of pigmentation around the nipple
What is the round ligament a remnant of?
Embryonic gubernaculum
What structures does the ovarian artery cross?
Ureter
What is the significance of the ovarian artery crossing the ureter?
Can be damaged in surgery
Watch in hysterectomy
What does the round ligament pass through?
The inguinal canal
Where does the ovarian artery arise from?
Abdominal aorta
At what level does the ovarian artery arise?
L2
What makes up the covering of alock’s/pudendal canal
Fascia of obturator internus
What makes up prostate histology
Glands
Stroma
How many layers of peritoneum is the broad ligament?
Double layer of peritoneum
