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My Reproduction > Anatomy > Flashcards

Anatomy Flashcards

1
Q

What does the pelvic cavity include?

A
  • ovaries
  • uterine tubes
  • uterus
  • superior vagina
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2
Q

What does the perineum include?

A
  • inferior vagina
  • perineal muscles
  • Bartholin’s glands
  • clitoris
  • labia
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3
Q

What is the true female reproductive organ?

A

ovaries

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4
Q

What covers the superior aspect of the pelvic organs?

A

parietal peritoneum

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5
Q

What is the most inferior part of the peritoneal cavity?

A
  • recto-uterine pouch/pouch of Douglas

- lateral para-recta fossae which extend down slightly more inferiorly

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6
Q

What is the broad ligament?

A

double layer of peritoneum extending between the uterus and the lateral walls and floor of pelvis

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7
Q

What is the round ligament?

A

embryological remnant of the gubernaculum which attaches to the lateral uterus and attaches in the superficial labia majora

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8
Q

What holds the uterus in position?

A
  • strong ligaments eg uterosacral ligaments
  • endopelvic fascia
  • muscles of the pelvic floor
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9
Q

What is the normal position of the uterus?

A

anteverted and anteflexed

variation is commonly retroflexed and retroverted

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10
Q

Where do you take the sample in a cervical screening test?

A

squamocolumnar junction at the external cervical os

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11
Q

What is the fornix?

A
  • small pouch created by the cervix holding open the vagina

- anterior, posterior and 2x lateral

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12
Q

What can you palpate digitally in the female system?

A
  • uterus
  • adnexae (uterine tubes and ovaries)
  • ischial spines
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13
Q

What makes up the diamond of the perineum?

A
  • pubic symphysis, two ischial spines and the coccyx

- split into anal triangle inferiorly and the urogenital triangle superiorly

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14
Q

What muscle forms the majority of the pelvic diaphragm?

A

levator ani

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15
Q

What is the levator ani?

A

skeletal muscle under voluntary control which reflexively contracts when there is increased intra-abdominal pressure

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16
Q

What is the nerve supply to the levator ani?

A

nerve to levator ani which is S3,4,5 but is likely to be a dual supply

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17
Q

What is the perineal body?

A
  • important for strength
  • bundle of collagenous and elastic tissue
  • just deep to the skin
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18
Q

What is Bartholin’s gland?

A

greater vestibular gland (Cowper’s glands in the male) which lubricates the opening of the vagina which can be infected or can have a cyst

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19
Q

Where is the female breast located anatomically?

A
  • ribs 2-6
  • mid-axillary line (tail of Spence)
  • lateral border of the sternum
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20
Q

What is under the breast tissue?

A
  • retromammary space

- pec major/serratus anterior

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21
Q

Where does the breast lymphatic system drain to?

A
  • ipsilateral axillary nodes
  • can drain to contralateral side
  • inner quadrants can drain to parasternal
  • lower quadrants can drain to abdomen
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22
Q

What is the blood supply to the breast tissue?

A
  • subclavian to the axillary

- internal thoracic

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23
Q

What is the role of the pelvic floor?

A
  • supports pelvic organs
  • separates the pelvic cavity from the perineum
  • maintains continence
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24
Q

What is the pelvic floor made up of?

A
  • pelvic diaphragm
  • muscles of the perineal pouches
  • perineal membrane
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25
Q

What is the pelvic diaphragm made up of?

A

levator ani and the coccygeus with anterior gap called the urogenital hiatus

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26
Q

What are the parts of the levator ani?

A
  • medial=puborectalis
  • middle=pubococcygeus
  • lateral=iliococcygeus
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27
Q

What is the levator ani innervated by?

A
  • pudendal nerve

- nerve to levator ani

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28
Q

What state does the levator ani remain in at rest?

A

tonically contracted and then relies to allow urination and defecation

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29
Q

What provides additional support for the organs?

A
  • endo-pelvic fascia
  • pelvic ligaments including uterosacral, transverse cervical ligament (aka cardinal), lateral ligament of bladder and lateral rectal ligament
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30
Q

Where is the deep perineal pouch?

A

between the fascia covering the inferior aspect of the pelvic diaphragm and the perineal membrane

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31
Q

What is contained within the deep perineal pouch?

A
  • urethra
  • vagina (F)
  • bulbourethral gland aka Cauper’s glands (M)
  • neurovascular bundle for penis/clitoris
  • extensions of the ischioanal fat pads
  • muscles: external urethral sphincter, compressor urethrae and deep transverse perineal muscle (M)/smooth muscle (F)
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32
Q

What is the perineal membrane?

A

thin sheet of deep fascia which attaches to the pubic arch and closes over the neurogenic triangle with openings for the urethra and vagina

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33
Q

Where is the superficial perineal pouch?

A

superficial to the perineal membrane

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34
Q

What is in the superficial perineal pouch in the female?

A
  • clitorus
  • crura
  • bulbs of vestibule
  • pudendal nerve
  • greater vestibular gland
  • muscles: bulbospongiosus, ischiocavernosus and superficial transverse perineal muscle
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35
Q

What is in the superficial perineal pouch in the male?

A
  • bulb of the penis
  • crura
  • pudendal nerve
  • muscles: ischiocavernosus, bulbospongiosus and superficial transverse perineal
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36
Q

What are the layers of the perineum from deep to superficial?

A
  • pelvic diaphragm (levator ani and coccygeus)
  • deep perineal pouch
  • perineal membrane
  • superficial perineal pouch (erectile tissue then muscles superficially)
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37
Q

What is the perineal body?

A

ball of fibrous tissue with skeletal and smooth muscle that supports the pelvic floor

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38
Q

What does the pelvic floor do when there is increased intra-abdominal pressure?

A

active contraction eg in coughing, sneezing or vomiting

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39
Q

How is urinary continence maintained?

A
  • external urethral sphincter
  • compressor urethrae
  • levator ani
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40
Q

How is faecal continence maintained?

A

puborectalis tonically and actively when rectum has filled

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41
Q

What are the mechanism of injury to the pelvic floor?

A
  • pregnancy/childbirth causing pudendal nerve injury
  • chronic constipation
  • obesity
  • heavy lifting
  • chronic cough/sneeze
  • menopause
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42
Q

What are the types of vaginal prolapse?

A

-cystocele (bladder)
-enterocele (SI)
-rectocele (rectum)
cause a lump in the vaginal wall

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43
Q

What are the types of uterine prolapse?

A
  • 1st degree: cervix into vagina
  • 2nd degree: cervix into opening of vagina
  • 3rd degree: cervix outside of vagina
  • 4th degree: entire uterus outside vagina
44
Q

What is the surgical treatment for prolapse?

A

sacrospinous fixation can be done by attaching sutures to sacrospinous ligament to stop add support but risk to nerves

45
Q

What is the mesh surgery for incontinence?

A

mesh through obturator foramen to make sling behind urethra

46
Q

What bones meet in the acetabulum?

A

ilium
pubis
ischium

47
Q

Where does the sacrospinous ligament attach and what does it form?

A
  • sacrum and ischial spine

- greater sciatic foramen

48
Q

Where does the sacrotuberous ligament attach and what does it form?

A
  • sacrum and ischial tuberosity

- lesser sciatic foramen

49
Q

Where is the obturator membrane?

A

covers the obturator foramen except for allowing nerves and vessels through

50
Q

Where does the levator ani attach?

A

on both sides to the tendinous arch of levator ani which is a band of thickened fascia from the obturator muscle

51
Q

Where does the coccygeus lie?

A

deep surface of the sacrospinous ligament

52
Q

What is the lateral pelvic wall supplied by?

A

internal iliac artery

exceptions are gonadal artery and the superior rectal artery

53
Q

What is the arterial supply to the female pelvis?

A
  • internal iliac is divided into:
  • posterior (supplies parietal)=gluteal arteries (variation with the inferior gluteal so it might come from the anterior division)
  • anterior (supplies viscera)= obturator artery (goes through obturator canal), superior vesical arteries (supply bladder), uterine artery (gives off vaginal artery), internal pudendal artery (this supplies the perineum by branches), middle rectal
54
Q

What are the important anastomoses of the uterine artery?

A
  • with the ovarian artery’s tubal and ovarian branches

- with the vaginal artery

55
Q

What is the ‘water under the bridge’?

A

ureter going under the uterine artery

56
Q

What branches does the internal pudendal artery give off in the female?

A

inferior rectal artery, perineal artery and terminates as the dorsal artery of the clitoris supplying the perineum

57
Q

What is the difference to the male arterial system compared to the female?

A
  • uterine artery is replaced with artery to vas deferens

- vaginal artery is replaced with the inferior vesical artery

58
Q

What do the artery to VD and prismatic branch come from?

A

inferior vesical arteries

59
Q

What are the branches of the internal pudendal artery in the male?

A
  • supplies the perineum in the male
  • branches are the perineal artery, posterior scrotal, deep artery, dorsal artery of the penis but the anterior scrotal artery is a branch of the internal iliac
60
Q

What is the medial umbilical ligament?

A

remnant of the umbilical artery and is present in both males and females

61
Q

What is the venous drainage of the pelvis?

A

-form venous plexus and most drain into the internal iliac vein
-some drain via superior rectal to hepatic portal system
-some drain via lateral sacral veins into internal vertebral venous plexus
!!think mets!!

62
Q

What is the obturator nerve formed of?

A

L2-4

63
Q

What is the path of the pudendal nerve?

A

in through the sciatic foramen and back into perineum by lesser sciatic foramen

64
Q

What are the nerves to the lateral pelvic wall?

A
  • most formed from the sacral plexus

- most important = sciatic nerve, pudendal (S2,3,4), nerve to levator ani and pelvic splanchnic nerves

65
Q

What are the lymphatic nodes in the pelvis?

A
  • deep inguinal
  • superficial inguinal
  • internal iliac
  • external iliac
  • common iliac
  • lumbar
  • inferior mesenteric
  • sacral
  • pararectal
66
Q

What is the path of the superior pelvic viscera lymph?

A

external iliac nodes –> common iliac –> aortic –> thoracic duct

67
Q

What is the path of the inferior pelvic viscera lymph?

A

deep perineum

  • -> internal iliac
  • -> common iliac –> aortic –> thoracic duct
68
Q

Where does the superficial perineal lymph drain to?

A

superficial inguinal nodes

69
Q

Where does the lymph from the ovaries and testes drain to?

A

lumbar nodes (as they originated on the posterior abdominal wall)

70
Q

What bones fuse in the hip joint?

A

ilium
pubis
ischium
all join in the acetabulum

71
Q

What is the pelvic inlet formed of?

A
  • sacral promontory
  • ilium
  • superior pubic ramus
  • pubic symphysis
72
Q

What is the pelvic outlet formed of?

A
  • pubic symphysis
  • ischiopubic ramus
  • ischial tuberosities
  • sacrotuberous ligaments
  • coccyx
73
Q

What are the palpable bony features of the pelvis?

A
  • iliac crests
  • ASIS
  • PSIS
  • sacrum
  • pubic tubercle
  • pubic symphysis
  • coccyx
  • ischial tuberosity
74
Q

What bony features of the pelvis can be palpated internally?

A

sacral promontory and the ischial spines (at 4 and 8 o’clock) on vaginal exam

75
Q

What type of joints are the hip joint and the pubic symphysis?

A

hip joint = synovial

pubic symphysis = secondary cartilaginous

76
Q

What is the role of the sacrospinous and sacrotuberous ligaments?

A
  • make sure the coccyx and sacrum aren’t pulled too superiorly in a weight transfer
  • create the two sciatic foramen
77
Q

What causes the ligaments of the pelvis to relax in pregnancy?

A

relaxin causes sacrospinous and sacrotuberous ligaments to relax

78
Q

What are the features of a foetal skull?

A
  • anterior fontanelle (closes 18m and 2y)
  • posterior fontanelle (closes 6m and 1y)
  • can be moulding which involves movement of one bone over another to allow foetal head to pass through pelvis
  • vertex area between anterior and posterior fontanelle and the two parietal eminences
79
Q

What is the important fact about size of baby’s head?

A

occipitofrontal diameter is longer than the biparietal diameter so the baby has to go sideways through the pelvic inlet

80
Q

What is ‘station’ in relation to childbirth?

A
  • negative station is when the baby hasn’t reached the ischial spines in decent
  • positive station is the baby is more inferior to spines
81
Q

How does the baby exit the pelvic outlet?

A
  • exits in the OA position so back of the head at the pubic symphysis
  • head goes from flexion to extension during labour
  • one last rotation to get shoulders out of the outlet
82
Q

What is the type of innervation to the pelvis?

A

sympathetic, parasympathetic and visceral afferent so body cavity

83
Q

What is the type of innervation to the perineum?

A

somatic motor and somatic sensory so body wall (pudendal nerve to S2-4) eg inferior vagina, perineal muscles, glands and skin

84
Q

What is the path of nerves to superior pelvic organs/touching peritoneum?

A
  • carried within visceral afferents
  • run alongside sympathetic fibres for pain
  • enter spinal cord between T11-L2
  • pain is perceived as suprapubic
  • eg uterine tubes, uterus and ovaries
85
Q

What is the path of nerves to inferior pelvic organs/not touching peritoneum?

A
  • within visceral afferents
  • run alongside the parasympathetic fibres for pain
  • enter spinal cord at S2-4 so this is where pain is perceived
  • eg cervix and superior vagina
86
Q

What is the innervation of structures that cross the levator ani?

A
  • above the levator ani = with parasympathetics
  • after levator ani = somatic as it is perineum with pudendal nerve
  • !!same levels for both but different nerves
87
Q

What are the nerve plexuses of the pelvis?

A
  • sympathetics of the pelvis = superior hypogastric plexus
  • parasympathetics of the pelvis = sacral outflow (S2-4) from spinal roots and mix with sympathetics in inferior hypogastric plexus
88
Q

What are the features of spinal anaesthetic?

A
  • anaesthetic is injected into L3-4 (the intercristal line goes nearly through L4)
  • through dura and arachnoid mater and into the subarachnoid space
  • sympathetic innervation is also blocked to everything below so there will be vasodilation of lower limb arterioles but beware of hypotension
89
Q

When does the spinal cord become the caudate equina?

A

L2

90
Q

When does the subarachnoid space end?

A

S2

91
Q

What are the features of epidural anaesthetic?

A

needle goes through supraspinous, interspinous, ligamentum flavum and into epidural space

92
Q

How is pudendal nerve block given?

A

use the ischial spine as a landmark PV to give anaesthetic vaginally with needle

93
Q

What is an episiotomy?

A
  • posterolateral incision done to stop perineum or pelvic floor muscles
  • easier to repair an incision and you can direct a tear away from the external anal sphincter
94
Q

What does a lower segment C section incision go through?

A 
skin + fascia
anterior rectus sheath
rectus abdominis
fascia + peritoneum
retract bladder
uterine wall
amniotic sac
95
Q

What does a laparotomy incision go through?

A

skin + fascia
linea alba
peritoneum
!!bloodless so increased chance of wound complications

96
Q

Where is a laparoscopy incision?

A

subumbilical incision or lateral port
(careful to avoid inferior epigastric artery which is just medial to the deep inguinal ring and runs superomedially behind the rectus abdominis)

97
Q

Where does the external oblique attach?

A

between the lower ribs and iliac crest, pubic tubercle and linea alba (hand in pockets)

98
Q

Where does the internal oblique attach?

A

between lower ribs, thoracolumbar fascia, iliac crest and linea alba (hug yourself)

99
Q

Where is the neurovascular plane in the abdomen?

A

between the transversus abdominis and internal oblique

100
Q

Where does the transversus abdominis attach?

A

between lower ribs, thoracolumbar fascia, iliac crest and linea alba

101
Q

What is the transversals fascia?

A

sheet of internal lining which is under the transversus abdominis

102
Q

What divides up the rectus abdominis?

A
  • tendinous intersections horizontally

- linea alba vertically which goes from the xiphoid to the pubic symphysis

103
Q

What does the arcuate line mark the change of?

A
  • inferiorly, all of the aponeuroses are anterior to the rectus abdominis
  • superiorly, the aponeuroses are both anterior and posterior to the rectus abdominis
104
Q

Where is the arcuate line?

A

1/3rd of the way from umbilicus to pubic symphysis

105
Q

What is the nerve supply to the anterolateral abdominal wall?

A
  • enter from lateral
  • move in neurovascular plane
  • 7th-11th intercostal nerves become thoracoabdominal nerves
  • T12 is subcostal
  • L1 splits into iliohypogastric (S) and ilioinguinal (I)
106
Q

What is the arterial supply to the anterior abdominal wall?

A
  • superior epigastric arteries (continuation of internal thoracic)
  • inferior epigastric arteries (branch of external iliac)
107
Q

What is the arterial supply to the lateral abdominal wall?

A

intercostal and subcostal arteries

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