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203: Theme 2 > Anatomy > Flashcards

Anatomy Flashcards

1
Q

What are modalities are used to image the pelvis?

A
  • MRI
  • U/S
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2
Q

What are the advantages and disadvantages of MRI?

A
  • No Ionising radiation
  • Better soft-tissue contrast
    • useful for staging cancers/tumours
  • Longer examination time (45 mins)
  • More expensive
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3
Q

When would a CT be used to image the pelvis?

A
  • In an emergency or acute settings
    • produces a lot of artefact due to the pelvic girdle
  • also has poor soft-tissue contrast
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4
Q

What key structures are in the male pelvis at this level?

A
  • Prostate
  • Rectum
  • Ischio-rectal fossae
    • cancers of the rectum erode into this area - looking for a clean line of fat (not present in this image)
  • Obturator internus
    • provides lateral rotation and the abduction of the hip
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5
Q

What key structures are in the male pelvis at this level?

A
  • rectus sheath at the front
  • the bladder
  • the seminal vesicles (bowtie)
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6
Q

What key structures are in the female pelvis at this level?

A
  • Uterus
    • Endometrium (looks bright white in T2)
    • Myometrium (same density as skeletal muscle)
    • Junctional zone
      • if this is narrowed or thickened –> suggest endometrial cancer
  • Ovary- fluid-filled and bright on the T2 weighted image
  • Bladder
  • Cervix
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7
Q

What can be seen in this Sagittal MRI of the female pelvis?

A
  • Bladder
  • Uterus (OM)
    • (anteverted uterus in this image- no functional difference)
  • Cervix
  • Rectum
    • the sacral space should have a clear line fo fat - sigmoid colon cancer can infiltrate into this space
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8
Q

How are the ovaries imaged?

A
    • HSG: Hysterosalpingogram
      • very similar to a smear test
      • you want to see a blurring from the contrast - shows the infundibulum is clear
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9
Q

The Peritoneum in the female pelvis - sagittal MRI -

A
  • The peritoneal reflections in the pelvis consist of the peritoneum wrapping around
    • the bladder
    • the uterus
    • the rectum
  • this creates two pouches/spaces
    • vesicouterine pouch
    • rectouterine pouch (pouch of Douglas)
  • the pouches are a common site of infection/ abscess
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10
Q

The peritoneum in the male pelvis - sagittal MRI -

A
  • there is only the vesicorectal pouch - as the perineum wraps around the bladder and down the front of the rectum
    • common site of abcist formation
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11
Q

What types of Ultrasound imaging can be down to image the pelvis?

A
  • Transabdominal
  • Transvaginal
  • Transrectal
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12
Q

What is measured in an Ante-natal ultrasound?

A
  • 12 week scan (dating scan)
  • 20-week scan (looking for congenital abnormalities)
    • growth rate: crown-rump length, head measurements etc.
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13
Q

How is the vascular anatomy of the pelvis?

A
  • Magnetic Resonance Angiography (using contrast (e.g gadolinium), similar to MRI)
  • Duplex U/S (doppler effect)
    • plots the wave form blood flow of the artery
  • CT angiogram
    • iodinated intra-venous contrast through the peripheral cannula with imaging
  • Angiography (direct catheter angio)
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14
Q

What type of imaging is this?

A

Duplex ultrasound of the right renal artery

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15
Q

What type of imaging is this?

A

CT Angiogram

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16
Q

What type of imaging is this?

A

Catheter angiogram

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17
Q

At what level does the aorta and vena cava bifurcate?

A
  • aorta is L4
  • vena cava is L5:
    • the right CIA crosses the origin of the Left CIV –> left iliac DVT
    • May-Thurner syndrome
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18
Q

Anatomy of the Internal Iliac artery

A
  • Divides into the Anterior and posterior division
    • the posterior division is iliolumbar
    • lumbosacral and superior gluteal
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19
Q

What pathology is this?

A

Unifying Pseudoaneurysm of the Right Common Femoral Artery

  • the blood vessel isn’t dilating there is just a hole in it
20
Q

Labelled anatomy of the sagittal female pelvis

A
21
Q

What is the blood supply and nerve supply of the ovaries?

A
  • supplied by the ovarian artery and the vein within the suspensory ligament
  • Nerve supply of the ovarian plexus
22
Q

Describe the structure of the uterine tube

  • VAN
A
  • Infandibulum
  • Ampulla
    • often the site of fertilization
  • Isthmus
  • Uterine
  • VAN
    • V: ovarian arteries pass laterally and drain into the left renal vein (on the left side), drain into the inferior vena cava (on right side)
    • A: ovarian artery
    • N: sympathetic supply from the ovarian nerve and parasympathetic from the pelvic splanchnic nerve
23
Q

Where is pain from the ovaries felt in which dermatome region?

A
  • ischaemia and pain which is referred to the dermatome region of T10
24
Q

Describe the structure of the uterus

A
  • made up of the fundus, body of the uterus and cervix
  • Formed of 3 layered walls
    • Perimetrium – outer serous wall covering the uterus
    • Myometrium – thick muscular layer, responsible for the process of parturition
    • Endometrium – inner mucous layer; site of implantation; thickness changes through menstrual cycle
25
Q

What is this innervation and supply of the uterus?

A
  • Innervation: symp from the hypogastric plexus (along uterine artery); parasymp via the pelvic splanchnic n.
  • Arterial supply: uterine artery
  • Venous drainage: via the uterine plexuses to the internal iliac veins
  • Touch and Pain (birth): via somatic afferents to S2-S4
26
Q

What are the key uterine ligaments?

A
  • Ligament of ovary
  • Round ligament of uterus
    • remnants of the gubernaculum
    • from the uterus to the labia majora- the route the process the ovaries would have taken if it was male and would have formed the scrotum
    • women who are pregnant may report a pulling
  • Broad ligament
    • covers over the uterine body and ovaries
    • forms the mesosalpinx when it pinches around the uterine tube
    • forms the mesovarium when it pinches around the ovaries
  • Transverse cervical ligament
  • Uterosacral ligament
  • Peritoneal pouches- trapped fluid where infection can take place
    • Vesicouterine pouch
    • Rectouterine pouch
27
Q

Describe the structure of the vagina

  • VAN
A
  • musculomembranous tube 7-9cm long
  • has to recesses superiorly
    • Posterior fornix
    • Anterior fornix
  • VAN
    • V: drainage though the vaginal plexus to the internal iliac veins
    • A: by branches from the internal iliac arteries
    • N: autonomic nerves, sensory nerves convey pain messages to an area of the abdomen supplied by T12 and L1 spinal nerves
28
Q

Review the vasculature of the female reproductive tract organs

A
29
Q

What structures make up the external female genitalia?

A

Consists of:

  • Mons pubis,
  • Labia majoria,
  • Bulb of vestibule
  • Clitoris- erectile organ consists of: root, body and glans
  • Bulb of vestibule- erectile tissue over bulbospongiosus muscle
  • Vestibular glands- secrete mucus
  • Labia minora encloses the vestibule (openings for vagina and urethra) and the clitoris
  • Blood supply/drainage: pudendal artery (erectile) & vein
  • Innervation: branches of genitofemoral and pudendal n (e.g. dorsal n of clitoris)
30
Q

What changes happen to the female reproductive tract during pregnancy?

A
  • Uterus expands from 50g to 950g.
  • Uterus extends to the xiphisternum.
  • Centre of gravity is altered-increased lumbar lordosis.
  • Sacroiliac joint and pubic symphysis relaxes
  • With uterine expansion the ovaries and uterine tubes are displaced laterally. The cervix becomes softer and swollen.
31
Q

What is the VAN of the testis?

A
  • V: form the pampiniform plexus
    • forms around the testis that keep it cool
  • A: supplied by the testicular artery
  • N: spermatic plexus
32
Q

Describe the structure of the testis

A
  • The dorsolateral surface of each testis is overlain by the epididymis which has an expanded ‘head’ connected to the superior part of the testis.
  • The seminiferous tubules in each testis drain, via a series of tubules, into the single duct of the epididymis at the head of the epididymis.
  • In the epididymis, the duct of the epididymis is tightly coiled and it continues as the uncoiled ductus (vas) deferens at the inferior pole of the epididymis.
33
Q

What are the three fascial layers of the testis?

A

these are continuous with the layers of the surrounding spermatic cord

  • The outer layer, the external spermatic fascia, is derived from the external oblique aponeurosis.
  • The middle layer, the cremaster muscle and fascia, is derived from the internal oblique and transversus abdominis.
    • the cremaster muscle lifts the testis back into the abdomen when it isunder threat or if it’s cold
  • The inner layer, the internal spermatic fascia, is derived from transversalis fascia.
34
Q

What is the microscopic structure of the seminiferous tubules?

A
  • Each testis is subdivided into approx. 250 pyramid-shaped lobules contain seminiferous tubules
  • Function- production of spermatozoa (spermatogenesis)
  • Structure- highly tortuous, lined by seminiferous epithelium
  • Tunica propria-loose C.T, fibroblasts and myoid cells
  • Stroma-surrounds seminiferous tubules, loose C.T, vascular and houses small clusters of large interstitial cells of Leydig
  • Sertoli Cells
    • Stretch from basal lamina to the lumen, linked by tight junctions
    • perform many roles in the testis
35
Q

What is the role of Sertoli Cells?

A
  • Stretch from basal lamina to the lumen, linked by tight junctions
  • Enfold developing spermatozoa-acting to
    • Protect them from antibodies in the blood
    • Provide nutrients
    • Phagocytose excess cytoplasm
    • Secrete androgen binding protein
    • Secrete inhibin
    • Add fluid to the lumen
36
Q

What is the VAN of the Ductus Deferens?

A
  • Arteries: those that primarily supply the lower bladder – inferior vesical– and rectum – middle rectal.
  • Venous: blood follows the arteries and so have the same name.
37
Q

What is the function of eh vas deferens and where is it found?

A
  • the tube continuous with epididymis that is joined by duct seminal gland => ejaculatory duct
  • The ductus deferens (vas deferens) ascends on the medial side of the epididymis,
  • enters the spermatic cord and then passes through the inguinal canal on its way to the urethra.
  • Spermatozoa, with their accompanying fluid (from the seminal vesicles and prostate), are then discharged by a closed duct system
38
Q

What are the accessory glands of the Ductus deferens?

  • what are their roles?
A
  • Seminal vesicles – just inferior to rectovesical pouch, secretes alkaline fluid + fructose + coagulate
  • Prostate – secretes prostatic fluid (20% total volume)
  • Bulbourethral glands – pea sized glands; a.k.a. Cowpers glands; located inferior to prostate; secretion assists lubrication of ducts and removes any urine that would have been in the tract
39
Q

What is the VAN of the Prostate?

A
  • Supplied by prostatic arteries and veins,
  • Innervated by sympathetic from inferior hypogastric and parasympathetic from pelvic splanchnic nerves
40
Q

What is the VAN of the Seminal Vesicles?

A
  • Wall of sac contains smooth muscle, which when stimulated by sympathetic nerves expels fluid out-ejaculation.
  • Blood: Inf vesicle + prostatic vessels (int iliac a)
41
Q

What is the VAN of the bulbourethral gland?

A
  • inferior vesicles + prostatic vessels and the internal iliac arteries
42
Q

What is the VAN of the penis?

A
  • A: Internal pudendal arteries
  • V: External pudendal veins.
  • N: by S2/4 Pudendal nerve, dorsal nerve to penis, ilioinguinal nerve
43
Q

Describe the gross anatomy of the penis

A
  • Consists of
    • root,
    • body and glands,
    • the body contains 3 cylindrical bodies
  • Paired corpora cavernosa and 1 corpus spongiosum
44
Q

What are the various parts of the male Urethra?

A
  • Prostatic
  • Membranous
  • Penile
45
Q

Explain the stages of Erection Emission and Ejaculation in males during sexual stimulation

A
  • Erection- Deep arteries-supply the corpora-in flaccid state A/V shunts
    • Increased parasympathetic nerve supply, increases blood flow- diverted to vascular spaces
    • this causes increased pressure in erectile tissue thus decreasing venous return
  • Emission- semen is delivered to the prostatic urethra, prostatic fluid added.
    • Emission results from sympathetic activity.
  • Ejaculation-semen expelled through the urethra
  • Inhibition of sympathetic supply-return to flaccid state
46
Q

What clinical pathologies arise from the male reproductive tract?

A
  • Testicular Torsion
  • Cryptorchidism
  • Patent processus vaginalis
  • Hydrocele
  • Hematocele

203: Theme 2 (11 decks)

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