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Fellows 2021! > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Posterior division of the internal iliac

A

I LOVE SEX

Iliolumbar
Lateral sacral
Superior gluteal

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2
Q

Anterior division of the internal iliac

A 
Obturator
Umbilical
Superior vesical
Inferior vesical
Internal pudendal (inferior rectal)
Inferior gluteal
Middle rectal
Uterine
Vaginal
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3
Q

Vascular supply of the ureter

A

Renal, gonadal, aorta, common iliac, internal iliac, superior vesical, uterine, middle rectal, vaginal, inferior vesical (lots of collateral blood flow)

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4
Q

Pudendal artery path

A

Supplies perineum.
Exits pelvis via greater sciatic foramen caudal to piriformis. Reenters pelvis through lesser sciatic foramen through Alcock’s canal.

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5
Q

Midline avascular spaces

A

Retropubic (Space of Retzius)
Vesicovaginal
Rectovaginal (Pouch of Douglas)
Presacral

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6
Q

Paired lateral avascular spaces

A

Paravesical
Pararectal

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7
Q

Space of Retzius contents

A

Plexus of Santorini
Cooper’s ligament (bilateral)
Dorsal clitoral artery (midline)
Obturator bundle (laterally)

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8
Q

Borders of the Space of Retzius

A 
Pubic symphysis (anterior)
Obturator internus (bilateral)
Bladder (posterior
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9
Q

Vesicovaginal space borders

A 
Bladder adventitia (anterior)
Bladder pillars (bilateral)
Vaginal/endopelvic fascia (posterior)
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10
Q

Rectovaginal Space (Pouch of Douglas) borders

A

Vagina (anterior)
Rectum (posterior)
Uterosacral ligaments (bilateral)

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11
Q

Significance of Pouch of Douglas

A

Extension of the peritoneum covering surfaces of vagina and rectum. Lowest point in the pelvis - dependent space for ascites and spread of disease.

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12
Q

Presacral Space borders

A

Rectum (anterior)
Sacrum (posterior)
Uterosacral ligaments/ureter (bilateral)
Waldeyer’s fascia and levator ani (inferior, 3-5cm proximal to anorectal junction)

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13
Q

Presacral space contents

A

Middle sacral artery

Hypogastric plexus

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14
Q

Paravesical space borders

A 
Pubic symphysis (anterior)
Cardinal ligaments (posterior)
External iliac vein/obturator muscle (lateral)
Umbilical artery (medial)
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15
Q

Paravesical space contents

A

Obturator nerve

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16
Q

Pararectal space borders

A

Cardinal ligaments (anterior)
Sacrum (posterior)
Internal iliac artery (lateral)
Rectum/ureter (medial)

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17
Q

Blood supply of the small bowel

A

SMA, middle colic, arcades and straight arteries

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18
Q

Blood supply of the large bowel

A

Marginal artery of Drummond (anastomotic loop with SMA and IMA)

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19
Q

Bowel most at risk for watershed injury

A

Left colic/splenic flexure (least anastamoses)

20
Q

Celiac trunk blood supply and branches

A

Blood supply to foregut and spleen

Branches: left gastric, splenic, common hepatic

21
Q

SMA blood supply and branches

A

Blood supply to midgut

Middle and right colic, inferior pancreaticoduodenal, jejunal branches, ileal branches, ileocolic

22
Q

IMA blood supply and branches

A

Blood supply to hindgut

Left colic, sigmoid, superior rectal

23
Q

Inferior phrenic arteries supply?

A

Blood supply to diaphragm

24
Q

Median sacral artery

A

Blood supply to sacrum - UNPAIRED

25
Q

Risks of diaphragm stripping/dissection

A

Hemorrhage (IVC, hepatic vasculature), pneumothorax, hepatic injury, phrenic nerve injury (diaphragm paralysis)

26
Q

Mobilizing the Spleen - what needs to be cut?

A 
Splenic artery and vein (splenic hilum) 
Gastrosplenic ligament
Splenocolic ligament
Splenorenal ligament 
Phrenocolic ligament 
VERY proximal to tail of pancreas
27
Q

Ligaments of the liver

A

Falciform
Triangular (right and left)
Coronary
Ligamentum teres hepatis (obliterated umbilical vein)

28
Q

Foramen of Winslow

A 
Omental foramen (lesser omentum, superior to stomach)
Allows access to porta hepatis
29
Q

Greater and lesser omental sac

A

Greater - below stomach, anterior to bowel

Lesser - posterior and superior to stomach

30
Q

Morrison’s Pouch

A

Hepatorenal recess, potential space between liver and right kidney
Lowest point in RUQ when supine, frequent site of metastasis from ovarian or appendiceal cancer

31
Q

Hepatorenal Recess

A

Morrison’s Pouch, potential space between liver and right kidney
Lowest point in RUQ when supine, frequent site of metastasis from ovarian or appendiceal cancer

32
Q

Gerota’s fascia

A

Renal fascia

33
Q

Ligament of Treitz

A

Suspensory ligament of the duodenum

Suspends the duodenojejunal junction to the Celiac trunk

34
Q

White Line of Toldt

A

Lateral reflection of posterior parietal peritoneum over the mesentery of the ascending and descending colon. Avascular plane for incision, mobilization of colon.

35
Q

Lumbar plexus nerve roots, and what nerves does it give rise to?

A

L1-4

Genitofemoral, lateral femoral cutaneous, femoral

36
Q

Genitofemoral nerve roots, function, and injury

A

L1-2
Sensory to upper anterior thigh, mons, and labia majora
Injury via retractor placement or transection

37
Q

Lateral femoral cutaneous nerve roots, function, injury

A

L2-3
Sensory to anterior lateral thigh
Injury via compression due to hip hyperflexion

38
Q

Femoral nerve roots, function, injury

A

L3-4
Motor function to knee extensors, sensory to upper inner thigh
Injury via retractor placement, positioning intraop, child birth, inguinal LND –> absent knee jerk reflex

39
Q

Obturator nerve root, function, injury

A

L3-4
Motor adduction of thigh, sensory to medial distal thigh
Injury via transection, sling placement, or pelvic LND

40
Q

Sacral nerve plexus nerve roots, and what nerves does it give rise to?

A

L4-5, S1-4

Superior and inferior gluteal, posterior femoral cutaneous, sciatic, pudendal

41
Q

Sciatic nerve root, function, path, gives rise to?

A

L4-S3
Motor and sensory components
Exits pelvis through greater sciatic foramen inferior to the piriformis, courses along posterior thigh to popliteal fossa
Terminates into tibial and common fibular (peroneal) nerves

42
Q

Tibial nerve function

A

Motor and sensory to posterior compartment of the leg and foot

43
Q

Common fibular (peroneal) nerve function and injury

A

Motor and sensory to anterior/lateral compartments of the leg and foot
Injury due to insufficient padding of the knee during surgery –> foot drop

44
Q

Pudendal nerve root, function, gives rise to?

A

S2-4 (keeps the penis off the floor!)
Gives rise to inferior rectal, perineal, dorsal clitoral
Motor and sensory to all perineal structures

45
Q

Superior hypogastric plexus

A

Bifurcates to the left and right over the sacrum

Visceral afferent fibers relay pain sensation. These are transected for dysmenorrhea treatment. L3-4, S2-4

46
Q

What plexus is at risk in Radical Hysterectomy or LAR?

A

Right and Left inferior hypogastric plexus (hypogastric nerves merge with pelvic splanchnic nerves)
Pelvic = Parasympathetic, visceral afferent nerve fibers.
Sacral splanchnic nerves = sympathetic

Fellows 2021! (10 decks)

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