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Anatomy Flashcards

1
Q

What are the functions of the bony pelvis

A

Support of the upper body when sitting and standing
Transfers weight from single vertebral column to bilateral femurs
Attachment for muscles of locomotion and abdominal wall
Attachment for external genitalia
Protection of pelvic organs, their blood & nerve supplies, their venous and lymphatic drainage
Passage for childbirth

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2
Q

Which bones form the bony pelvis

A

2 hip bones - made up of ilium, ischium and pubis
Sacrum
Coccyx

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3
Q

What forms the sub-pubic angle

A

The joins of the two pubic bones

Creates an arch which creates the angle

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4
Q

What forms the pelvic inlet

A

sacral promontory
ilium
superior pubic ramus
pubic symphysis

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5
Q

What forms the pelvic outlet

A 
pubic symphysis
ischiopubic ramus
ischial tuberosities
sacrotuberous ligaments 
coccyx
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6
Q

Where is the pelvic cavity found

A

Sits within bony pelvis between pelvis inlet and pelvic floor
Continuous with the abdominal cavity above

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7
Q

What is found in the pelvic cavity

A

The pelvic organs and supporting tissues

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8
Q

Where can you palpate the ischial spines

A

On internal examination of a female
At the 4 and 8 o’clock positions
Used to measure station in labour

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9
Q

Which parts of the pelvis are palpable

A

On deep palpation can feel pubic symphysis and tubercle
Iliac crests are palpable
Ischial tuberosity can be felt when sitting down
Ischial spines palpable internally

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10
Q

What joints are found in the pelvis

A

Sacroiliac joints - synovial
Hip joint - synovial
Pubic symphysis - secondary cartilaginous

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11
Q

What happens to the pelvic ligaments in pregnancy

A

They relax

This is due to the hormones - relaxin

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12
Q

Name the two main ligaments of the pelvis

A 
Sacrotuberous ligament (sacrum to ischial tuberosity)
Sacrospinous ligament (sacrum to ischial spine)
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13
Q

What are the functions of the pelvic ligaments

A

Help to stabilise pelvis joint during weight bearing

Ensure the sacrum isn’t pushed superiorly when weight is transferred vertically - jumping etc

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14
Q

Describe the relationship between the pelvic ligaments and the sciatic foramen

A

The 2 ligaments divide it into the greater and lesser sciatic foramen (important for passage of nerves/vessels into lower limb/perineum)

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15
Q

Describe the structure and contents of the obturator foramen

A

It is entirely covered by ligament except for tiny area that has obturator canal
The obturator nerve and vessels pass through here to supply the medial thigh

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16
Q

What is the main concern with a fractured pelvis

A

The potential damage to the structures held within it - can lead to life threatening haemorrhage
less concern about the bones themselves

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17
Q

The pelvis usually fractures in multiple places - true or false

A

True
Bony pelvis is a ring, so must fracture in multiple places (minimum 2)
Or it is combined with joint dislocation

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18
Q

Which blood vessels can be damaged in pelvic trauma

A

External and internal iliac artery/veins with their branches

If damaged this can cause a life threatening haemorrhage - lot of blood in the pelvis

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19
Q

List the differences between the male and female pelvis

A

Female has bigger openings (inlet and outlet)
Pubic arch and subpubic angle much bigger in female
Pelvic cavity is more shallow in women
Female is more rounded and male is more love heart
All to prep for childbirth

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20
Q

What is meant by moulding of the foetal skull

A

When the bones are able to move over one another to allow the head to pass in labour

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21
Q

What are the fontanels

A

2 diamond shaped areas - anterior and posterior - which are gaps between the skull bones
Just covered by a membrane - called the soft spot
Also have mastoid and sphenoid ones that are less clinically relevant

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22
Q

What is the vertex of the skull

A

Seen in the foetal skull

Diamond shaped area between the2 parietal eminences (bulges) and the anterior and posterior fontanelles

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23
Q

Describe the dimeters of the foetal skulls

A

The occipital frontal dimeter is the longest

Skull is longer than it is wide

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24
Q

Which diameter of the female pelvis is greatest

A

Transverse diameter in female greater than AP diameter

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25
Q

How should the baby enter the pelvic cavity

A

Should be facing either left or right so that the OP diameter of their skull matches the transverse diameter of the pelvis (2 largest ones)

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26
Q

How do you measure the station of labour

A

Palpate the distance of the foetal head from the ischial spines
If above spines = negative station
If below its a positive station

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27
Q

How should the baby pass through the pelvis

A

Enter the pelvic cavity facing to the side (transverse)
As it descends the head should rotate and be flexed
At the pelvic outlet the AP diameter becomes widest so the head needs to be vertical (OA) so that they line up
Foetal head should be extended on delivery
There is further rotation to deliver the shoulders

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28
Q

Which parts of the female reproductive system are found in the pelvic cavity

A

Ovaries
Uterine tubes
Uterus
Superior part of vagina

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29
Q

Which parts of the female reproductive system are found in the perineum

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

What is the primary organ of female reproduction

A

Ovary

All others are considered secondary or accessory

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31
Q

What separates the pelvic cavity and perineum in women

A

The levator ani muscle (forms the pelvic floor)

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32
Q

What is the peritoneum

A

Peritoneum is a very thin, serous membrane layer that covers the abdominal organs and entire pelvis
It forms the floor of peritoneal cavity and is a roof over pelvic organs

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33
Q

What pouches are formed by the peritoneum in women

A

vesico-uterine

recto-uterine (pouch of Douglas)

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34
Q

What is the clinical importance of the pouch of Douglas

A 
It is usually the most inferior part of the peritoneal cavity 
Therefore excess (abnormal) fluid within the peritoneal cavity tends to collect here
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35
Q

How can you drain fluid from the pouch of Douglas

A

By inserting a needle through the posterior fornix of the vagina

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36
Q

Which part of the female reproductive tract is intraperitoneal

A

The uterine tubes

As the peritoneum drapes over the uterine tube it will come back down the other side so it is completely surrounded

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37
Q

What is the broad ligament of the uterus

A

A double layer of peritoneum that extends between the uterus and the lateral walls and floor of the pelvis
Formed by peritoneum draping over the uterine tubes and coming together underneath

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38
Q

What is contained within the broad ligament of the uterus

A

contains the uterine tubes and the proximal part of the round ligament

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39
Q

What is the function of the broad ligament of the uterus

A

helps maintain the uterus in its correct midline position

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40
Q

What is the round ligament of the uterus

A

Round ligament is the embryological remnant of the gubernaculum – thought to help guide the ovaries from the posterior abdominal wall to their correct position
Sometimes called the ligamentum teres

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41
Q

Where does the round ligament of the uterus run

A

Attaches to the lateral aspect of the uterus

It passes through the inguinal canal (via the deep ring) and down into the labia

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42
Q

What are the 3 layers of the uterus

A

perimetrium
myometrium - thick muscular layer
endometrium - shed in menstruation

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43
Q

Where does implantation of an embryo occur

A

In the body of the uterus

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44
Q

What is an ectopic pregnancy

A

Implantation of an embryo anywhere other than the body of the uterus
The foetus will not survive

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45
Q

Why is ectopic pregnancy a medical emergency

A

A rupture will lead to a big haemorrhage that will kill mum

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46
Q

Where can ectopic pregnancies occur

A

Most ectopic pregnancies will occur in the uterine tubes

Some can occur in the abdomen

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47
Q

What holds the uterus in position

A

number of strong ligaments - e.g. uterosacral
Endopelvic fascia
Muscles of the pelvic floor (e.g. levator ani)

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48
Q

What happens if the support structures of the uterus are weakened

A

If any of these supports are weakened you become prone to prolapse
Uterus descends down into the vagina

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49
Q

What is the normal position of the uterus

A

Anteverted and anteflexed
Anteverted means the cervix is tipped anteriorly relative to the axis of the vagina

Anteflexed mean the uterus is tipped anteriorly relative to the axis of the cervix (the mass of the uterus lies over the bladder)

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50
Q

What is a retroverted uterus

A

cervix is tipped posteriorly relative to the axis of the vagina
No effect really just a normal variation

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51
Q

What area is samples during a cervical smear

A

Have to sample the transformation zone of the cervix – where you move from internal part of cervix to external (cell type changes)
This is the most common area for dysplasia

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52
Q

How do the vaginal walls usually sit

A

Walls of the vagina are usually collapsed and touching each other
This is why you need to insert the speculum for smears

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53
Q

Where does fertilisation occur

A

Ampulla of the uterine tube

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54
Q

What is the term for removal of the tubes and ovaries

A

bilateral salpingo-oophrectomy

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55
Q

Are the abdominal cavity and genital tract connected

A

Yes

There is a direct communication as the fimbriated end of the tubes open directly into the peritoneal cavity

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56
Q

What is the clinical significance of the connection between the abdomen and reproductive tract

A

Any genital infections can spread up and cause peritonitis

Ectopic pregnancies can develop in the abdomen

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57
Q

Where are the ovaries found

A

Ovary are found on the lateral wall of the pelvic cavity (in ovarian fossa)
Moved here by round ligament

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58
Q

Describe the blood supply to the ovaries

A

The arterial, venous and lymphatics supply of the ovaries come from the posterior abdominal wall as this is where they originate

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59
Q

What are the vaginal fornices

A

Small spaces at the top of the vagina around the cervix

It has 4 parts anterior, posterior and 2x lateral

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60
Q

Where can the ischial spines be palpated

A

Inside the vagina

Laterally at the 4 and 8 o’clock positions

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61
Q

How can you palpate the uterus

A

Bimanual palpation
One hand in vagina other on abdomen
If felt it is anteverted

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62
Q

How can you palpate the adnexae (ovaries and tubes)

A

place examining fingers into lateral fornix
press deeply with other hand in the iliac fossa of the same side
repeat on other side

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63
Q

What is the perineum

A

Shallow area between the pelvic floor and the perineal skin
Split into 2 triangles – urogenital and anal
Contains the openings of the pelvic floor

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64
Q

Describe the levator ani muscle

A

It is made up of smaller muscles and makes up most of the pelvic floor
Its skeletal so under voluntary control

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65
Q

What is the function of the levator ani muscle

A

Provides continual support for the pelvic organs - always tonically contracting
Will reflexively contract if there is an increase in pressure such as sneezing, coughing, lifting weights to prevent incontinence

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66
Q

What supplies the levator ani muscle

A

Nerve to the leavtor ani - S3,4,5

Some supply from pudendal nerve as well

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67
Q

What is the perineal body

A

Bundle of collagenous and elastic tissue into which the perineal muscles attach
Just deep to the skin
Important to pelvic floor strength

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68
Q

When might the perineal body get damaged

A

During childbirth
It will massively impact pelvic floor strength
Try and protect it from tears etc

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69
Q

What are the bartholins glands

A

Glands found in the perineum which secrete mucus to lubricate the entrance to the vagina
Very painful when infected

70
Q

Where are the female breasts found

A

From ribs 2-6
From lateral border of sternum to mid-axillary line
Lies on the deep fascia of the pecs
HAs an axillary tail

71
Q

What makes up the breast

A

Fatty tissue and non-lactating lobules all around the breast
In later stages of pregnancy the lobules become lactating – fill up with milk

72
Q

What is the retromammary space

A

Space between the fascia of the pec and the breast

It allows the breast to move against the muscles

73
Q

What attaches the breast to the skin

A

Firmly attached via suspensory ligaments

74
Q

How do you assess a breast lump

A

Position described in relation to the 4 quadrants - upper/lower outer/inner
Have to assess whether the lump is fixed to underlying tissue or not
Both the axilla and supraclavicular area should be assessed

75
Q

Where does lymph from the breasts drain

A

Most lymph drains to axillary nodes on the same side and then to the supraclavicular nodes
However lymph from inner breast quadrants can drain to the parasternal lymph nodes - can cross side
Lower quadrants can drain to abdominal nodes

76
Q

What structures are found in the axilla

A

brachial plexus branches
axillary artery and axillary vein (& their branches)
axillary lymph nodes
all embedded in axillary fat

77
Q

Describe the levels of axillary node clearance

A

Level I – inferior and lateral to pectoralis minor

Level II – deep to pectoralis minor

Level III – superior and medial to pectoralis minor

78
Q

What is the blood supply of the breast

A

Most blood supply comes from internal thoracic artery (branches off the subclavian)
Some from axillary

79
Q

Which general type of nerves supply the structures of the pelvis

A

sympathetic, parasympathetic and visceral afferent

80
Q

Which general type of nerves supply the structures of the perineum

A

somatic motor and somatic sensory

81
Q

What types of nerves carry pain from the adnexae, uterus and vagina

A

Visceral afferents

Lower vagina (perineal section) is somatic sensory

82
Q

What type of nerve carry pain from the perineum

A

Somatic sensory

83
Q

What type of nerve is responsible for pelvic floor contraction

A

Somatic motor

84
Q

What type of nerve is responsible for uterine cramping and contraction

A

hormonal Sympathetic/parasympathetic

85
Q

Where do the visceral afferents of the superior pelvic organs (touching peroneum) enter the spinal cord

A

Run alongside sympathetic fibres

Enter spinal cord between levels T11-L2

86
Q

Where is pain from the superior pelvic organs felt

A

Suprapubic

87
Q

Where do the visceral afferents of the inferior pelvic organs enter the spinal cord

A

Run alongside parasympathetic fibres

Enter spinal cord at levels S2, S3, S4

88
Q

Where is pain from the inferior pelvic organs felt

A

Pain perceived in S2, S3, S4 dermatome (perineum)

89
Q

Describe the sympathetic supply to the pelvis

A

Sacral sympathetic trunks
From T11-L2
Superior hypogastric plexus

90
Q

Describe the parasympathetic supply to the pelvis

A

Sacral outflow (S2, 3, 4)
Pelvic splanchnic nerves
Emerge from spinal roots
Mixes with sympathetics in inferior hypogastric plexus

91
Q

Which two spinal levels will pain from the reproductive system go to

A

T11-L2 and S2-S4
T = visceral afferents from uterine tubes, uterus and ovaries
S - visceral afferents from cervix and superior vagina and the pudendal nerve

92
Q

What structures are supplied by the pudendal nerve

A

inferior vagina, perineal muscles, glands, skin.
Sensory to external genitalia, anus and perineum
Motor to the muscles

93
Q

What are the roots of the pudendal nerve

A

S2-4

94
Q

What are the options for labour anaesthesia

A

Spinal anaesthetic

Epidural anaesthetic

Pudendal nerve block

95
Q

At what level do you inject the anaesthetic for a spinal or epidural

A

The L3-4 region

96
Q

AT what level does the subarachnoid space end

A

S2

97
Q

At what level does the spinal cord become the cauda equina

A

Level of the L2 vertebrae

98
Q

List the layers the needle for an epidural must pass through

A 
Skin 
supraspinous ligament
interspinous ligament
ligamentum flavum
epidural space (fat and veins)
99
Q

List the layers the needle for an spinal anaesthetic must pass through

A 
Skin 
supraspinous ligament
interspinous ligament
ligamentum flavum
epidural space (fat and veins)
dura mater
arachnoid mater
finally reaches subarachnoid space (contains CSF)
100
Q

At what spinal levels do the sympathetic nerves exit the spinal cord

A

T1-L2

101
Q

How do sympathetic signals reach below the level of L2

A

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

102
Q

What are the side effects of a spinal anaesthetic

A

Vasodilation of all arterioles of the lower limb
Skin looks flushed, is warm and has reduced sweating
Can lead to hypotension
Headache if there is a CSF leak

103
Q

Which nerves are affected by a spinal anaesthetic

A

All spinal nerves and their named nerves containing sympathetic fibres
including femoral, sciatic, obturator, pudendal

104
Q

Describe the path 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 ( in obturator fascia)
Branches to supply structures of the perinuem

105
Q

What passes through the pudendal canal

A

Pudendal nerve
Internal pudendal artery and vein
Nerve to obturator internus

106
Q

What can a pudendal nerve block be used for

A

During labour - forceps delivery, painful vaginal delivery or for an episiotomy
Before perineal suturing post tear

107
Q

How do you find the pudendal nerve for a block

A

The ischial spine can be used as a landmark - feel inside vagina
Inject over lateral aspect of sacrospinous ligament
This is found medially to the spines

108
Q

What are the effects of a perineal tear

A

Weakened pelvic floor and faecal incontinence could result

109
Q

What is an episiotomy

A

Posterolateral (mediolateral) incision made into the ischioanal fossa
Done to avoid an uncontrolled tear and try and protect the anus and rectum

110
Q

What forms the lateral pelvic wall

A

Ilium makes up most of the lateral pelvic wall
Small contribution from pubis and ischium
Obturator membrane (with obturator canal), sacrotuberous and sacrospinous ligaments

111
Q

Describe the arteries of the pelvis

A 
Majority of arteries of pelvis and perineum arise from internal iliac artery
Exceptions:
Gonadal arteries (ovaries/testes) come from abdominal aorta (L2)
Superior rectal for rectum comes from abdominal aorta

There are lots of anastomoses

112
Q

What is the blood supply to the penis

A 
Dorsal artery (corpus spongiosum + glans)
Deep artery (corpus cavernosum – most of blood during an erection)

Both are branches of the internal pudendal artery

113
Q

What are the branches of the internal pudendal artery in men

A

Perineal artery
Dorsal artery
Deep artery

114
Q

Where does the uterine artery come from

A

Comes from the anterior division of the internal iliac

This comes from the common iliac

115
Q

Where does the vaginal artery come from

A

Branches from the uterine artery

116
Q

What does the uterine artery anastomose with

A

Vaginal artery and the ovarian artery

117
Q

Where does blood from the pelvis drain to

A

Some will drain via superior rectal into hepatic portal system
Some will drain via lateral sacral veins into internal vertebral venous plexus

118
Q

List the major lymphatic groups of the pelvis

A 
Pararectal 
Deep inguinal 
Superficial inguinal 
Internal iliac 
External iliac 
Common iliac 
Sacral 
Inferior mesenteric 
Lumbar
119
Q

Which lymph nodes do the superior pelvic organs drain to

A

external iliac to common iliac to aortic then thoracic duct

120
Q

Which lymph nodes do the inferior pelvic organs drain to

A

Internal iliac nodes to common iliac to aortic then to thoracic

121
Q

Where does lymph from the ovaries/testes drain to

A

Lumbar nodes

122
Q

Where does lymph from the clitoris and penis drain to

A

Deep Inguinal

123
Q

What makes up the pelvic floor

A

3 layers (inner to outer)

Pelvic diaphragm - deepest layer which includes 2 muscle groups, levator ani and coccygeus

Muscles of perineal pouches

Perineal membrane - superficial layer

124
Q

What is the function of the pelvic floor

A

Separates pelvic cavity from perineum

Plays important role in providing support to pelvic organs - tonically contracted

Actively contracts during sneezing or coughing

Plays an important role in maintaining continence - both urinary and faecal

125
Q

Which muscles make up the pelvic diaphragm

A

Levator ani and the coccygeus

Coccygeus is located inferiorly

126
Q

Where does the levator ani attach

A

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

127
Q

Which muscles make up the levator ani

A

Puborectalis
Pubococcygeus
Iliococcygeus

128
Q

What innervates the levator ani

A

The pudendal nerve (S2,3,4) and nerve to levator ani

129
Q

What is found in the deep perineal pouch

A 
Contains part of the urethra 
Vagina in females
Bulbourethral glands in male
Neurovascular bundle for penis/clitoris
Extensions of the ischioanal fat pads
Smooth muscles
External urethral sphincter and
compressor urethrae
130
Q

Where is the deep perineal pouch found

A

Lies below the fascia covering the inferior aspect of the pelvic diaphragm

Lies above the perineal membrane

131
Q

Describe the structure of the perineal membrane

A

Thin sheet of tough, deep fascia found superficial to the deep perineal pouch
Attaches laterally to the sides of the pubic arch, closing the urogenital triangle
Openings for the urethra (and vagina in females)
It provides an area of attachment for the external genitalia

132
Q

What is found in the superficial perineal pouch in men

A

It contains the root of the penis and the spongy urethra

133
Q

What is found in the superficial perineal pouch in women

A

Contains female erectile tissue and associated muscle:
Clitoris and crura – corpus cavernosum
Bulbs of vestibule
Associated muscles
Branches of internal pudendal vessels and pudendal nerve
Also contains greater vestibular glands,
superficial transverse perineal muscle

134
Q

What can cause injury to the pelvic floor

A

Pelvic floor trauma and denervation

  • Pregnancy
  • Childbirth
  • Previous injury to pelvis/pelvic floor
  • Previous surgery
  • Congenital issues

Increased intra-abdominal pressure

  • Chronic constipation
  • Obesity
  • Heavy lifting
  • Chronic cough or sneeze
  • Abdominal mass
Connective tissue disorders 
- Menopause (oestrogen deficiency)
- Age related 
- Congenital or acquired
 connective tissue disorders, - Drug related: e.g. steroids
135
Q

What is a vaginal prolapse

A

Herniation of urethra, bladder, rectum or rectouterine pouch through supporting fascia

Presents as a lump in vaginal wall

136
Q

How does a uterine prolapse present

A

dragging sensation
feeling of ‘lump’
urinary incontinence

137
Q

How can you repair a uterine prolapse

A

Pessaries
Physio
Sacrospinous fixation -sutures placed in sacrospinous ligament
Performed vaginally

138
Q

What can cause urinary incontinence

A

Sphincter incompetence (stress)
Detrusor instability (urge)
Retention
Functional

139
Q

What are the risk factors for urinary incontinence

A

Being female (pregnancy, childbirth, menopause, short urethra)
Age (more likely the older you are)
Weight (being overweight increases pressure on bladder)
Smoking (chronic cough)
Diabetes and kidney disease

140
Q

What is considered abnormal urinary frequency

A

More than 8 times per day is abnormal

141
Q

How can you treat an overactive bladder

A 
Lifestyle advice 
Bladder drill 
Pelvic floor exercises 
Drugs (anticholinergics) 
Botox 
Neuromodulation Reconstructive surgery
142
Q

What is the first line drug for an overactive bladder

A

Pteridine

143
Q

When is urodynamics indicated

A

Indicated for hesitancy, voiding difficulty, neuropathy, history of retention

144
Q

What is urodynamics

A
  • Test done to determine why the bladder is leaking

Measure the volume of urine expelled from the bladder each second (tells you the flow rate)

145
Q

What are the degrees of uterine prolapse

A 
1st = in vagina 
2nd = at the introitus (the opening) 
3rd = outside the vagina (over 1cm beyond interoitus)
4th = all outside with the uterus (procidentia)
146
Q

If the fontanelle is sunken, what does it suggest

A

Dehydration

147
Q

If the fontanelle is swollen, what does it suggest

A

Hydrocephalus

148
Q

When do the fontanelles close

A

From 18 months to 2 years

149
Q

What type of nerve fibres does the pudendal nerve contain

A

Somatic motor and sensory

Sympathetic

150
Q

What is a cystocele

A

Hernial protrusion of the bladder into the vaginal wall

151
Q

What structures are found in the spermatic cord

A 
Vas deferens 
Testicular artery
Pampiniform venous plexus 
Lymphatics 
Sympathetic and genital nerves
152
Q

Are uterine contractions affected by a pudendal nerve block

A

No as the uterus is not supplied by the pudendal nerve

This allows labour to progress

153
Q

What is a normal testicular volume/size

A

15-25ml is normal volume

5cm in size

154
Q

What is the clinical relevance of the ischioanal fossa

A

Usually just filled with fatty tissue but infection can easily spread through it
Abscesses can form in here

155
Q

What is the risk of sacrospinous fixation in prolapse repair

A

Risk of injury to pudendal neurovascular bundle and sciatic nerve

156
Q

What is meant by trans-peritoneal spread

A

When disease can penetrate through the peritoneal layer and disseminate into the peritoneal cavity
The peritoneal layer is only a single cell epithelium so aggressive cancer or infection can penetrate it

157
Q

Describe how the vagina is supported vertically - level 1 support

A

Vertical suspension of the uterus, cervix and
vagina provided by the uterosacral and cardinal
ligaments
At the apex and lower third of the vagina

158
Q

Describe how the vagina is supported laterally - level 2 support

A

Lateral attachment of the vagina in its middle
third, provided by connective tissue known as
paravaginal fascia
It connects the vagina to the ‘white line’ or arcus
tendineus fascia pelvis (ATFP) - part of the origin of
levator ani.

159
Q

Describe how the vagina is supported in its lower 3rd - level 3 support

A

Lower third of the vagina is supported by the
fusion of the vaginal endopelvic fascia to the perineal
body posteriorly, the levator ani muscles laterally and
urethra anteriorly.

160
Q

What is both the somatic and autonomic supply to the vagina

A

Somatic nerve supply: S2-4.

Autonomic nerve supply: Inferior hypogastric plexus.

161
Q

Failure of level 1 (vertical) vaginal support causes which type of prolapse

A

uterine or vault prolapse

Can also cause incontinence

162
Q

Failure of level 2 (lateral) vaginal support causes which type of prolapse

A

Cystocele

163
Q

Failure of level 3 vaginal support causes which type of prolapse

A

Rectocele

Also causes urethral mobility and stress incontinence

164
Q

What triggers the micturition reflex

A

As bladder fills it stimulates sensory receptors in wall - pass impulses to S2-4, which ascend to
higher centers via the lateral spinothalamic tracts.
The descending impulses inhibit detrusor contraction

First sensation to void occurs when bladder is around half full
The impulses continue as volume increases until acceptable
place to void is found - detrusor still inhibited

165
Q

Describe the initiation phase of the micturition reflex

A

The pelvic floor relaxes -simultaneous relaxation of extrinsic
and intrinsic striated muscle,
Then there is suppression
of descending inhibitory impulses leading to detrusor
contraction.
The parasympathetic system inhibits
the resting tone of the urethral smooth muscle,
resulting in relaxation
stimulated
parasympathetic fibres from S2-4 via the hypogastric
nerve, release acetylcholine which binds to M2 and
M3 muscarinic receptors in bladder, resulting in
detrusor contraction.

166
Q

Detrusor overactivity results in which medical condition

A

Urge incontinence

167
Q

Describe the voiding phase of micturition

A

Rising intravesical pressure and falling urethral pressures
equate leading to urine flow and bladder emptying
As intravesical pressure falls toward end of
micturition , the pelvic floor and urethral muscles
contract, causing urethral closure and interruption of
flow, finalising the cycle.

168
Q

Which muscles provide urinary continence

A

External urethral sphincter
Compressor urethrae
Levator ani

169
Q

Which muscles provide faecal continence

A

Contraction of puborectalis muscle

170
Q

The normal state of the pelvic diaphragm muscle is contracted - true or false

A

True
They must relax to
release urine and faeces

171
Q

Which nerves innervate the detrusor muscle

A

Parasympathetic nerves derived from the pelvic splanchnics, S 2, 3, 4

172
Q

Which urogenital organs can prolapse

A

Can involve the bladder (cystocele), uterus, vagina

and/or rectum (rectocele)

Reproduction (16 decks)

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