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Endo-Repro Final > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Why is it less common for children to get pelvic fractures than adults?

A

3 hip bones do not fuse together until puberty - held together by cartilage

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2
Q

What is the dividing line between ABD and pelvis?

A

pelvic brim

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3
Q

What space makes up the lesser (true) pelvis? What is found above it?

A
  • space between the pelvic brim and the pelvic floor/diaphragm
  • above it is the greater (false) pelvis that still contains ABD viscera
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4
Q

What contributes to the pelvic brim?

A
  • arcuate line of the ilium

- pectin pubis

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5
Q

What attaches to the pubic tubercle?

A

inguinal L. - from ASIS to pubic tubercle

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6
Q

What is the opening at the pelvic brim called? What is found below it?

A
  • opening at pelvic brim = pelvic inlet

- pelvic outlet found below it

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7
Q

Describe general structure of male and female pelvis

A

Male - thick and heavy

Female - thin and light

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8
Q

Describe greater and lesser pelvis of males and females

A

Male - narrow and deep greater/lesser pelvis

Female - wide and shallow greater/lesser pelvis

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9
Q

What is the shape of the pelvic inlet in males and females?

A

Male - heart-shaped and narrow

Female - oval/rounded and wide

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10
Q

What is the pubic arch and subpubic angle in males and females?

A

Male - narrow arch (< 70)

Female - wide arch ( > 80)

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11
Q

What is the shape of the obturator foramen in males and females?

A

Male - round

Female - oval

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12
Q

Who has a larger acetabulum: males or females?

A

males

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13
Q

What is the degree of the greater sciatic notch in males and females?

A

Male - narrow (70)

Female - almost 90

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14
Q

What part of the pelvis is likely to fracture from anterior-posterior compression?

A

pubic rami

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15
Q

What part of the pelvis is likely to fracture from lateral compression?

A

acetabulum and ilum

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16
Q

Name the 4 weak areas of the pelvis?

A
  • pubic rami
  • acetabulum
  • SI joint
  • iliac ala (wings)
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17
Q

What is L5 spondylolysis?

A

separation of the vertebral arch from vertebral body

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18
Q

What is L5 spondylolisthesis?

A

abnormal anteriorly directed separation of the L5 vertebral segment from the sacrum

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19
Q

Describe the locations of the iliolumbar L. and lumbosacral L.?

A
  • iliolumbar L. - L5 TP to iliac crest

- lumbosacral L. - L5 TP to sacral ala

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20
Q

What makes up the greater and lesser sciatic foramen?

A

sacrospinous L. (greater) and sacrotuberous L. (lesser)

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21
Q

What is the action of the obturator internus M. and piriformis M.? Where do they both attach?

A
  • laterally rotate the thigh (external rotation)

- both attached to greater trochanter of femur

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22
Q

What is the function of the coccygeus M.?

A

supports pelvic viscera and supports coccyx (keeps it in flexion)

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23
Q

Name 2 pelvic wall muscles

A

obturator internus M. and piriformis M.

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24
Q

Name 4 pelvic floor (diaphragm) Ms.

A
  • coccygeus M.
  • iliococcygeus M.
  • pubococcygeus M.
  • puborectalis M.
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25
Q

What 3 muscles make up the levator ani? Where are the located in relation to each other?

A
  • iliococcygeus M. - most lateral
  • pubococcygeus M. - middle
  • puborectalis M. - most medial
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26
Q

What 2 muscles are at risk of tearing during childbirth?

A

pubococcygeus M. and puborectalis M.

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27
Q

What is the tendinous arch of the elevator ani? What does it divide?

A
  • thickening of obturator internus fascia between ischial spine and pubic body
  • divides obturator internus into superior and inferior regions
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28
Q

What are the 2 openings created by pelvic floor muscles called and what passes through them?

A
  • levator hiatus

- rectum, urethra, and vagina (female)

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29
Q

What is an important function of the puborectalis M.?

A
  • helps maintain fecal continence - relaxes during urination/defecation
  • works independent of GI sphincters
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30
Q

What is the anorectal flexure?

A

encirclement of the rectum by levator ani (important for fecal continence)

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31
Q

Describe each of the following: anal column, anal valves, anal sinuses

A
  • anal column - longitudinal ridges in anal canal
  • anal valves - folds at base of anal columns
  • anal sinuses - adjacent to the valves (secrete mucus to help w/ defecation)
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32
Q

Where are the internal/external anal sphincters located in relation to each other?

A
  • internal = more medial

- external = more lateral

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33
Q

What type of muscle makes up the internal/external anal sphincters? Are they voluntary/involuntary?

A
  • internal = smooth muscle; involuntary

- external = skeletal muscle; voluntary

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34
Q

Which anal sphincter makes up the majority of the resting sphincter tone?

A

internal (70-85%)

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35
Q

What divides the anal canal into 2 regions? What is the embryologic origin of each region?

A
  • pectinate line
  • above the line (upper 2/3) = endoderm
  • below the line (lower 1/3) = ectoderm
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36
Q

What is the innervation of the superior/inferior anal canal?

A
  • superior: inferior hypogastric plexus (visceral innervation)
  • inferior: inferior rectal N. (from pudendal N.) - somatic innervation
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37
Q

What is the blood supply (artery) of the superior/inferior anal canal?

A
  • superior: superior rectal A (from IMA)

- inferior: inferior rectal A. (from internal iliac A. -> internal pudendal A.)

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38
Q

What is the venous drainage of the superior/inferior anal canal?

A
  • superior: superior rectal V. (IMV -> portal)

- inferior: inferior rectal V. (systemic: internal pudendal -> internal iliac -> common iliac -> IVC)

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39
Q

What is the lymphatic drainage of the superior/inferior anal canal?

A
  • superior: internal iliac nodes -> inferior mesenteric nodes
  • inferior: superficial inguinal nodes
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40
Q

What is the cause of internal hemorrhoids? What is seen with them? Are they painful?

A
  • prolapsed rectal mucosa due to weakened muscular mucosae - usually due to portal HTN
  • usually see bright red blood
  • visceral innervation (not painful)
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41
Q

What is the cause of external hemorrhoids? Are they painful?

A
  • external venous plexus covered w/ epidermis
  • increased pressure causes dilated veins to rupture
  • somatic innervation (painful)
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42
Q

What supplies lymph drainage to the superior/inferior rectum?

A
  • superior: pararectal nodes -> sacral nodes

- inferior: internal iliac nodes

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43
Q

Where is the pelvic pain line located? What carries afferent info to the CNS above and below the pelvic pain line?

A
  • located at the inferior limit of the peritoneum in pelvic cavity
  • above the line = sympathetics (T12-L2)
  • below the line = parasympathetics (S2-S4)
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44
Q

What is the deepest portion of the male and female peritoneal cavities? Why are these spaces important?

A
  • Male: rectovesical pouch (between rectum and bladder)
  • Female: rectouterine pouch (between rectum and uterus)
  • spaces where ABD fluid collects; likely to develop abscesses here
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45
Q

Describe each of the following: supravesical fossa, paravesical fossa, pararectal fossa

A
  • supravesical fossa: peritoneum on superior surface of bladder between median and medial umbilical folds
  • paravesical fossa: depressions on either side of bladder
  • pararectal fossa: pouches on either side of rectum
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46
Q

Describe each of the following: retropubic space and retrorectal space

A
  • retropubic space: between bladder and pubic bone

- retrorectal space: between rectum and sacrum

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47
Q

What prevents you from putting your hand down between the pubic bone and the prostate/bladder in males? What is similar in females?

A
  • puboprostatic L. in males

- pubovesical L. in females

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48
Q

What artery supplies the top of the bladder and where does it come from? Where is this artery found?

A
  • superior vesical A. -> comes from patent umbilical A.

- found within the lateral L. of the bladder

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49
Q

Name 2 ligaments that help support the bladder

A

pubovesical L. and lateral L. of the bladder

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50
Q

What is the thickened fascia between the lateral vagina and tendinous arch of levator ani called?

A

paracolpium

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51
Q

At what angle do the ureters enter the bladder and what does this allow?

A

enter bladder at an inferomedial angle - allows pressure of bladder filling to clamp the ureters shut and prevent back flow of urine

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52
Q

Are the kidneys and ureters peritoneal or retroperitoneal?

A

retroperitoneal

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53
Q

What do the ureters run inferior to in males and females?

A

males: inferior to vas deferens
females: inferior to uterine A. (A. wraps around ureter)

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54
Q

What 4 arteries help supply the ureters?

A
  • renal A.
  • gonadal A.
  • ABD aorta
  • common/internal iliac As.
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55
Q

Name 3 nerves that innervate the ureters

A
  • prearotic plexus
  • hypogastric plexus
  • pelvic splanchnic N. (parasympathetic)
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56
Q

What is connected to the apex of the bladder?

A

median umbilical L. (originally the urachus)

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57
Q

What type of epithelium are the ureters and bladder lined with?

A

transitional epithelium

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58
Q

What is the trigone of the bladder?

A

inferior/posterior wall where ureters and urethra open

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59
Q

What is the name of the smooth muscle lining the bladder wall?

A

detrusor M.

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60
Q

What type of muscle fibers make up the internal/external urethral sphincters?

A

internal: smooth muscle (continuous w/ detrusor M.)
external: skeletal muscle

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61
Q

Where are the internal/external urethral sphincters primarily located?

A
  • mainly in the membranous urethra
  • internal is continuous w/ bladder wall
  • external is considered part of pelvic floor
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62
Q

What is the innervation of the internal/external urethral sphincters?

A
  • internal: inferior hypogastric plexus; involuntary

- external: deep perineal branch of pudendal N.; voluntary)

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63
Q

What are the 3 regions of the male urethra? Which is the longest?

A
  • prostatic urethra (passes through prostate)
  • membranous urethra (contains sphincters)
  • spongy/penile urethra (longest)
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64
Q

Define each of the following: urethral crest, prostatic sinuses, seminal colliculus, prostatic utricle.

A
  • urethral crest: ridge in the prostatic urethra (thin on either end)
  • prostatic sinuses: holes on either side of ridge where prostate gland secretes prostatic fluid
  • seminal colliculus: enlarged portion of crest where 2 ejaculatory ducts open
  • prostatic utricle: remnant of paramesonephric system
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65
Q

What 2 things make up the ejaculatory ducts?

A

vas deferens (sperm) and seminal vesicle (fluid)

66
Q

What is the blood supply and innervation of the prostate?

A
  • blood supply: inferior vesicle A. and middle rectal A.

- innervation: prostatic plexus from inferior hypogastric plexus

67
Q

What are some sx of BPH?

A

nocturia, dysuria, and urinary urgency

68
Q

What is BPH and how would you detect it?

A

hypertrophy of the prostate into the urinary bladder - impedes urination and can lead to cystitis and kidney damage
- detected by a digital rectal exam

69
Q

Explain the route of the vas deferens

A
  • enters ABD via deep inguinal ring
  • passes superior to all structures
  • expands into an ampulla before narrowing again to join seminal vesicle duct
70
Q

Where are seminal vesicles located?

A

lateral on either side of the ampulla of the vas deferens

71
Q

What is the vascular supply of the seminal vesicles?

A

branches of superior and inferior vascular arteries

72
Q

What is the lymphatic drainage of the vas deferens?

A
  • scrotal portion: external iliac

- majority of vas deferens: internal iliac

73
Q

What is the lymphatic drainage of the prostate?

A

internal iliac (most) and some to the sacral nodes

74
Q

What is the lymphatic drainage of the bladder?

A
  • superior portion: external iliac

- inferior portion (fundus and neck): internal iliac

75
Q

What is the diagnostic procedure for bladder cancer?

A

cystoscopy

76
Q

What 2 pelvic spaces are located in both males and females? What space in a female is a pouch in a male?

A
  • retropubic space
  • retrorectal space
  • retrovesical space (pouch in males)
77
Q

Space vs pouch

A

space - cavity filled w/ fat

pouch - cavity lined w/ peritoneum

78
Q

What 2 pelvic pouches are unique to females?

A

vesicouterine pouch and the rectouterine pouch

79
Q

How can the rectouterine pouch be surgically approached?

A

through the posterior fornix of the vagina

80
Q

What is the broad L.?

A

double fold of peritoneum that goes over the top of the uterus/ovaries and attaches to the lateral wall of the pelvis

81
Q

What are the contents of the board L. (6)?

A
  • round L. (through inguinal canal and connects to uterus)
  • uterine tube
  • ovaries
  • uterus
  • proper ovarian L. (connects ovary to uterus)
  • ovarian vessels (within suspensory L.)
82
Q

Explain each of the following parts of the broad L.: mesometrium, mesovarium, mesosalpinx

A
  • mesometrium: surrounds the uterus
  • mesovarium: surrounds the ovaries
  • mesosalpinx: surrounds uterine tube
83
Q

What 2 ligaments combine to support the cervix?

A
  • transverse cervical L. (cardinal L.)

- uterosacral L.

84
Q

What L. provides the main support for the uterus?

A

transverse cervical L. (cardinal L.)

85
Q

What vessels run within each of the following Ls.: lateral bladder L., cardinal L., and uterosacral L.

A
  • lateral bladder L. - superior vesicular A. and V.
  • cardinal L. - uterine A. and V.
  • uterosacral L. - middle rectal A. and V.
86
Q

What are the 3 layers of the uterus?

A
  • perimetrium: outside adventitia layer
  • myometrium: muscular layer
  • endometrium: inner epithelium that changes w/ the menstrual cycle
87
Q

What are the openings on either side of the cervical portion of the uterus?

A

internal os and external os

88
Q

What are the 2 uterine positions? What are they called normally?

A
  • verted: angle between cervix and vagina (normally anteverted)
  • flex - angle between uterine body and cervix (normally anteflexed)
89
Q

What can having a retroverted uterus cause?

A
  • no effect on fertility but can cause lower back pain, dysuria, and dyspareunia (pain during intercourse)
90
Q

What can having a retroverted and retroflexed uterus cause?

A

can become trapped in curve of sacrum when pregnant

91
Q

What is uterine prolapse? What are the varying degrees?

A
  • when pelvic ligaments or pelvic diaphragm weakens/tears and can’t support the uterus (usually by pregnancy)
  • 1st degree: small prolapse into vagina
  • 2nd degree: uterus enters directly into vagina
  • 3rd degree: complete prolapse (vagina falls outside body)
92
Q

What are the 5 common parts of the uterine tube

A
  • fimbria: finger-like appendages that cover the ovary
  • infundibulum: funnel portion that takes up egg from ovary
  • ampulla: largest portion of tube
  • isthmus: narrow portion near the uterus
  • intrauterine portion
93
Q

What 3 ligaments are attached to the ovaries?

A
  • ovarian L. (round L. of ovary) - attaches ovary to uterus
  • suspensory L. - ovary to pelvic wall
  • broad L. via the mesovarium
94
Q

What is the fornix of the vagina?

A

recess of the vagina that protrudes past the opening to the cervix (due to angle of cervix)

95
Q

What helps increase the tone of the external urethral sphincter (EUS)?

A

pelvic floor exercises

96
Q

At what level is a spinal epidural nerve block injected?

A

L3-L4

97
Q

At what level is a caudal epidermal nerve block injected?

A

L5-S1

98
Q

How many arteries do males and females have that enter the lesser pelvis? What makes up the difference?

A

Males: 4 (testicular As. do not enter)
Females: 6 (paired ovarian As. enter)

99
Q

What are the common As. between males and females that enter the lesser pelvis?

A
  • paired internal iliac A. (x2)
  • median sacral A.
  • superior rectal A.
100
Q

What injury can occur when ligating the uterine A.?

A

can accidentally cut the ureter during a hysterectomy (uterine A. wraps around the ureter)

101
Q

What injury can occur when ligating the ovarian A.?

A

can accidentally cut the ureter during oophorectomy (ovarian A. is close to ureter at pelvic brim)

102
Q

Where do iliolumbar Vs. drain into?

A

drain directly into common iliac rather than internal iliac

103
Q

What do superior, middle, and inferior rectal Vs. anastomose as?

A

rectal portocaval anastomosis (portal system)

104
Q

What does the lateral sacral V. anastomose with and where does the anastomosis drain?

A

anastomoses w/ internal vertebral plexus -> IVC/SVC

105
Q

What are the 2 nerve plexuses of the pelvis?

A
  • sacral (lumbosacral) and coccygeal plexus
106
Q

What makes up the sacral (lumbosacral) plexus?

A

anterior rami of S1-S4 and lumbosacral trunk (L4-L5)

107
Q

Name the 4 branches of the sacral plexus?

A
  • sciatic N. (L4-S3)
  • superior gluteal N. (L4-S1)
  • inferior gluteal N. (L4-S2)
  • pudendal N. (S2-S4)
108
Q

What does the pudendal N. innervate?

A

innervates perineum and provides sensory afferents for external genitalia and anal canal (below pectinate line)

109
Q

What does the sciatic N. innervate?

A

hamstring muscles, leg and foot

110
Q

Which nerve from the sacral plexus exits the greater sciatic foramen and enters the perineum via the lesser sciatic foramen?

A

pudendal N. (PIN structures)

111
Q

Where would you perform a pudendal N. block/saddle block?

A

near inferior margin of ischial spine

112
Q

What do the superior and inferior gluteal Ns. innervate?

A
  • superior gluteal N.: gluteus medius and minimus ms.

- inferior gluteal N.: gluteus maximus

113
Q

What makes up the coccygeal plexus?

A

anterior rami S4-S5 and coccygeal Ns. (Co)

114
Q

What does the coccygeal plexus innervate?

A

coccygeus M., part of levator ani and sacrococcygeal joint

115
Q

What branch comes off the coccygeal plexus and what does it innervate?

A

anococcygeal Ns. -> innervate small area of skin between tip of coccyx and anus

116
Q

What makes up superior/inferior hypogastric plexuses (sympathetics or parasympathetics)?

A
  • superior: sympathetic

- inferior: sympathetic (superior sacral) and parasympathetic (pelvic splanchnic Ns.)

117
Q

What plexuses does the superior hypogastric plexus give rise to?

A

ureteric, testicular, and common iliac plexuses

118
Q

What 3 things communicate with the inferior hypogastric plexus

A
  • gray rami communicantes (feed sympathetic fibers into anterior rami)
  • pelvic splanchnic Ns. (parasympathetics to the plexus)
  • sacral splanchnic Ns. (sympathetics to the plexus)
119
Q

Which artery does the ureter cross anterior to?

A

common iliac A.

120
Q

From what lymph nodes do the common iliac nodes receive lymph? Where do they drain?

A
  • receive from sacral lymph nodes, internal iliac lymph nodes, and external iliac lymph nodes
  • drain into lumbar lymph nodes
121
Q

Where do sacral lymph nodes receive lymph from?

A

rectum, bladder, prostate, cervix, and posterior pelvic wall

122
Q

Where do internal iliac lymph nodes receive lymph from?

A

pelvic viscera, deep part of perineum, and gluteal region

123
Q

Where do external iliac lymph nodes receive lymph from?

A

deep inguinal lymph nodes anterior ABD wall, bladder, prostate, uterus and upper vagina

124
Q

What are the 2 branches of the external iliac A.?

A
  • deep circumflex iliac A.

- inferior epigastric A.

125
Q

What are the 3 branches of the posterior division of internal iliac A.?

A
  • iliolumbar A.
  • superior gluteal A.
  • lateral sacral A.
126
Q

What are the 6 branches of the anterior division of the internal iliac A. in females?
What branch comes off in males?

A
  • middle rectal A.
  • internal pudendal A.
  • vaginal A. (F)
  • uterine A. (F)
  • obturator A.
  • umbilical A.
  • inferior vesical A. (M)
127
Q

What artery supplies the urinary bladder in females? From what artery does it branch?

A

superior vesical A. -> comes from umbilical A.

128
Q

Where does the umbilical A. end?

A

ends in the medial umbilical L.

129
Q

What do inferior gluteal A. and inferior rectal A. branch off?

A

internal pudendal A.

130
Q

What is contained in the perineum?

A

external genitalia and anal canal

131
Q

What are the boundaries of the perineum?

A 
- Anterior: pubic symphysis
Posterior: coccyx
- Anterolateral: ischiopubic ramus
- Posteriolateral: sacrotuberous L.
- Superior: pelvic diaphragm
- Inferior: skin associated w/ external genitalia and anal canal
132
Q

What is contained within the anal triangle of the perineum?

A
  • anal canal (internal and external sphincters)
133
Q

What is the perineum divided into?

A

divided into a urogenital triangle (anteriorly) and an anal triangle (posteriorly)

134
Q

What are the boundaries of the ischiorectal fossa?

A
  • lateral wall - obturator internus and ischium
  • superomedial wall - levator ani and anal canal
  • base - skin of perineum
135
Q

Where is the pudendal canal?

A

fascia lined space on the medial surface of the obturator internus M.

136
Q

What passes through the pudendal canal?

A
  • pudendal N.
  • internal pudendal A.
  • internal pudendal V.
137
Q

What are the 2 spaces found within the urogenital triangle

A
  • superficial perineal space

- deep perineal space (contains urogenital diaphragm)

138
Q

What is the name of the lower layer of fascia on the urogenital diaphragm?

A

perineal membrane

139
Q

What is the narrowest portion of the male urethra?

A

membranous urethra (passes through urogenital diaphragm) - contains IUS and EUS

140
Q

Where does the duct of the bulbourethral gland empty? What does it pass through to do this?

A

passes through perineal membrane to empty into the spongy (penile) urethra

141
Q

What is the muscle that runs transversely across the urogenital diaphragm?

A

deep transverse perineum M.

142
Q

What are the 4 structures found at the root of the penis?

A
  • crura (2)
  • bulb of penis
  • ischiocaverous M. (covers the crura)
  • bulbospongiosus M. (covers the bulb)
143
Q

What helps empty the penis of urine/semen?

A

bulbospongiosus M.

144
Q

What is found in the shaft of the penis (5)?

A
  • corpus spongiosum (contains penile urethra)
  • corpus cavernosum (bilateral)
  • Dorsal A/V/N of the penis
145
Q

What does the vulva consist of (3)?

A
  • labia majora
  • labia minora
  • clitoris
146
Q

What is the space between the labia minora called?

A

vestibule of the vagina

147
Q

What is contained within the vestibule of the vagina?

A
  • external urethral orifice
  • vaginal orifice
  • paraurethral glands orifices
  • greater vestibular glands orifices
148
Q

What is another name for the greater vestibular glands and what is their function?

A

Bartholin’s glands - secrete clear mucus that lubricates external genitalia

149
Q

What are the 4 parts of the clitoris?

A
  • bilateral crura covered by ischiocavernosus M.
  • bilateral corpora cavernosus (continuous w/ crura)
  • body
  • glans clitoris (visibile externally)
150
Q

What does the bulbocavernosus M (bulbospongiosus M) cover over in females

A

bulb of vestibule and greater vestibular glands

151
Q

What does the external pudendal A. supply?

A

scrotum/penis (males) and labia majora/clitoris (females)

152
Q

What type of fibers does the pudendal N. contain?

A
  • preganglionic parasympathetic
  • postganglionic sympathetic
  • somatic motor and sensory fibers
153
Q

What 3 branches does the pudendal N. give off?

A
  • inferior rectal N.
  • perineal N.
  • Dorsal N. of penis/clitoris
154
Q

What are 6 causes of male impotence?

A
  • nerve damage to prostatic nerve plexus
  • atherosclerosis to blood supply of erectile tissues
  • NIDDM
  • spinal cord injury
  • hormonal disorders
  • psychological disorders
155
Q

What is the lymphatic drainage of the superficial perineal space?

A

superficial inguinal nodes

156
Q

What is the lymphatic drainage of the deep perineal space?

A

internal iliac nodes

157
Q

What is an episiotomy?

A

surgical incision between vagina and anus to prevent perianal tearing during vaginal delivery

158
Q

What type of episiotomy is the most common?

A

medio-lateral episiotomy

159
Q

What are the 3 layers that require sutures after an episiotomy?

A
  • vaginal wall
  • muscle layer
  • subcutaneous fascia
160
Q

What does the round L. of the uterus connect?

A

connects uterus to labia majora

161
Q

The inferior gluteal A. can branch of 2 different arteries, what are they?

A
  • internal pudendal A. from anterior division of internal iliac A.
  • posterior division of internal iliac A.

Endo-Repro Final (7 decks)

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