Anatomy Abdomen Flashcards
1
Q
What are the skeletal components of the abdominal wall?
A
- Five Lumbar vertebrae
- Superior expanded parts of pelvic bones
- costal margin rib XII, end of rib XI, xiphoid process
2
Q
What is the main muscle in the anterior abdominal wall?
A
Rectus Abdominis
+ Rectus sheath
3
Q
What is the rectus sheath?
A
A sheath which surrounds rectus abdominis
–> built by “Sehnenplatten” (
–< muss ergänzt werden!
4
Q
Intraperitoneal
A
structures that are suspended from abdominal wall by mesenteries
5
Q
Retroperitoneal
A
Structures not suspended in the abdominal wall but lie between the parietal peritoneum and abdominal wall
(e.g. kidney and ureters)
6
Q
Explain the nine-region pattern of the abdominal wall (Borders, planes)
A
Horizontal lines:
- Subcostal plane –> inferior to costal margins (rib X, LIII)
- Intertubercular plane —> Connects tubercles at iliac crest (5cm posterior of iliac spine)
Vertical lines:
- Midclavicular lines (from mid-clavicle to somewhere between anterior superior iliac spine and pubic symphysis)
7
Q
Name the nine regions of the abdomen
A
8
Q
What is the superficial fascia?
A
A layer of fatty, subcutaneous connective tissue of the abdominal wall
9
Q
A
Linea Alba:
10
Q
What is the function of the anterolateral muscles in the abdominal wall?
A
Maintainance of normal physiological functions
–> firm but flexible wall to keep abdominal viscera in the cavity
Can support quiet and forced expiration, coughing and vomiting
Involved in everything which requires increasing intrabdominal pressure
11
Q
Which one is the most superficial anterolateral abdominal muscle?
Where is it atached to?
A
Attached to lower 8 ribs
Free ends –> turns into aponeurosis (linea alba and inguinal ligament)
12
Q
In which direction does the external oblique abdominal muscles pass?
A
Inferomedial direction
Aponeurotic component covers the anterior part of the abdominal wall forming linea alba
13
Q
In which direction do muscle fibers of the internal oblique muscles pass?
A
Superior medial direction
Aponeurosis also blends into linea alba
14
Q
How it the deepest layer of abdominal muscles called?
In which direction does it pass?
A
Transversus abdominus
Across abdomen, blending into linea alba
15
Q
A
16
Q
A
17
Q
What is the transversalis fascia?
A
Fascia deep to transversus abdominis
–> basically forms fascia which is thicker and thinner at some point but connects through whole abdominal cavity and back
18
Q
A
Widens and thins from as ascending from pubic synthesis to costal margin
Paired muscle, separated by linea alba
19
Q
How are the abdominal muscels innervated?
A
Anterior rami of lower six thoracic spinal nerves (T7-T12)
L1 for Internal oblique and Transversus abdominis)
20
Q
What is the rectus sheath and how does it change over the different spinal levels?
A
What is it?
- Aponeurotic tendinous sheath surrounding rectus abdominis
- Formed by aponeurotic parts of internal, external oblique and transversus abdominis
Change
- A: encloses upper three-quarters of rectus abdominis
—> Anterior: External oblique, half internal oblique
—> Posterior: Half internal oblique, half transversus abdominis
- B: lower quarter: no posterior covering of rectus abdominis –> direct contact with transversalis fascia
—> Apneurotic tendons from all three muscles form anterior part
(Transition marked by arcuate line)
21
Q
What is the extraperitoneal fascia?
What does it separate?
A
It is a Layer of connective tissue which is thick in the posterior part of the abdominal wall
It separates the transversalis fascia from the peritoneum
22
Q
What is the peritoneum?
How can you classify the peritoneum?
A
It is a thin serous membrane lining the wall of the abdominal cavity and reflects onto abdominal viscera
Classification:
- Lining the walls: Parietal peritoneum
- Lining the viscera: visceral peritoneum
23
Q
Explain the route of cutaneous nerve innervation of the abdomen
A
Intercostal nerves (T7-T11) + T12+ L1
Intercostal nerves run deep in their costal cartilages, continue between transversus abdominis and internal oblique
Enter the rectus sheath and pass posterior to the lateral aspect of rectus abdominis
Pass through rectus abdominis to supply the skin
24
Q
By which nerve is the region around the umbillicus supplied?
A
T10
25
By which nerve is the inguinal ligament supplied?
L1
26
Summarise the blood supply of the superficial anterolateral abdominal wall
Superior part:
* **Musculophrenic artery** (terminal branch of internal thoracic artery)
Inferior part
* Medial: **Superficial epigastric artery**
* Lateral: **Superficial circumflex iliac artery**
--\> Both branches from femoral artery
27
Summarise the deeper blood supply of the anterior abdominal wall
Superior Part
* **Superior epigastric artery** (terminal branch of the thoracic artery)
Lateral part:
* **10+11 intercostal artery + subcostal artery**
Inferior part:
* **inferior epigastric artery** and **deep circumflex iliac artery** (both from femoral artery)
28
What is the faith of the superior and inferior epigastric arteries?
Both enter recuts sheath (always posterior to rectus abdominis) and anastomose with each other
29
In which two segments can the superficial fascia be devided?
Campers fascia: Superficial fatty fascia (varies in thickness)
Scarpas fascia: Deeper, thin and membranous
30
Summarise the layers (from superficial to deep) you cut when making an incision into the abdominal wall.
1. Skin
2. Superficial fascia: Campers fascia, Scarpans fascia
3. Muscles/Aponeuroses
4. Transversalis fascia
5. Extraperitoneal fascia
6. Peritoneum
31
What passes through the inguinal canal?
Genital branch of the **genitofemoral nerve**
Men: **Spermatic cord**
Women: **round ligament of uterus**
**ilio-inguinal** **nerve** thorough part of the canal (exit with other contents)
32
What it the deep inguinal ring?
Where is it located?
Beginning of the inguinal canal
--\> Begining of tubular evagination of the transversalis fascia (form internal spermatic fascia/ round ligament of uterus)
It is located midway between anterior superior ilia spine and the pubic symphysis (just above inguinal ligament, lateral to inferior epigastric vessels
33
What is the superficial or external inguinal ring?
What is itformed by?
It is the **end of the inguinal canal** --\> marks beginning of external spermatic fascia
Triangular opening in the **aponeurosis of the external oblique**
---\> other sides Attached to the pubic symphysis and pubic tubercle
34
Where are the superior and inferior crus of the superficial inguinal ring attached to?
Inferior= attached to the pubic tubercle
Superior= attached to pubic symphysis
35
What forms the,, bottom", floor of the inguinal canal?
What is the most inferior border of the inguinal canal?
The inguinal ligament
36
What forms the anterior side of the inguinal canal?
The aponeurosis part of the external oblique muscle
+ reinforced laterally by fibres of the internal oblique
37
By which structure its the roof (superior wall) of the inguinal canal formed?
Arching fibers of the **transversus abdominis** and **internal oblique muscle**
Come together to form **conjoint tendon** attached to the pubic symphisis
38
What forms the posterior wall of the inguinal canal?
**Transverse fascia**
Medial third: reinforced by **conjoint tendon**
39
What is the inguinal ligament?
Extension of the aponeurosis part of the external oblique muscles attached to the superior anterior pubic spine and pubic tubercle
40
What is a hernia?
Is is the formation of a sack by the parietal peritoneum (with or without content)
often occurring at weakened parts of the abdominal wall
41
What is the difference between a direct and an indirect hernia?
An indirect hernia passes through the inguinal canal while the direct hernia passes through a weakening of the abdominal wall
## Footnote
Direct: Direktes Durchtreten des Bruchsacks durch die Bauchwand ohne Beziehung zum Funiculus spermaticus
42
How long is the inguinal canal in adult males?
About 4 cm
43
Which type of hernia is more common in males than in females?
Indirect inguinal hernia
In females: most of the time a femoral hernia
44
In which area do most direct inguinal hernias occur?
In the Hesselbachs triangle
Boundaries:
Lateral: inferior epigastric artery
Medially: rectus abdominis
Interior: Inguinal ligament
45
How do you clinically distinguish between a femoral and an inguinal hernia?
Inguinal:
* Reducible
* above inguinal ligament
* (Male)
Femoral:
* Irreducible
* below inguinal ligament
* more common in females
46
What is the peritoneum?
Thin membrane (simple squamous) that lines walls of the abdominal cavity and many viscera
47
What are mesenteries
Folds of the peritoneum which contain abdominal organs
--\> Components of the GI tract are suspended in peritoneal reflections
48
What is the peritoneal cavity?
The space enclosed by the two layers of the peritoneum
49
How can the peritoneal cavity be subdivided?
Into
## Footnote
1. greater sac --\> most of the space from the diaphragm to pelvic cavity
2. Omental bursa: subdivision posterior to stomach and liver
---\> are continuous with each other
50
What is the function of the mesenteries?
These parietal folds **attach** some **viscera** **to the posterior abdominal wall**
They allow some movement and are **conduits for vessels, nerves and lymphatics**
51
What is the greater omentum?
Where does it attach and what are included structures?
It is a large peritoneal fold (green)
**Attaches to**: greater curvature of the stomach and first part of the duodenum
It normally contains an accumulation of fat + r**ight and left gastro-omental vessels** just inferiorly to the stomach
52
What is the lesser omentum?
What does it attach to?
Which structures does it contain?
A fold of the peritoneum
Extends from the lesser curvature of stomach + first part of the duodenum to the liver
It has a free edge (because of the ventral mesentery which ends at the midgut) where the **hepatic artery**, the **bile duct** and the **portal vein** run through
53
How can organs in the abdominal cavity be classified according to their relation with the peritoneum?
**Inraperitoneal**= in suspended from abdominal wall by mesenteries
**Retroperitoneal**= organs held between abdominal wall+ parietal peritoneum
54
In what three compartments can the GI tract be separated?
* FOREGUT– Distal 3rdof oesophagus to the 2ndpart of the duodenum at the entrance of the bile duct (Major duodenal papilla).
* MIDGUT– 2ndpart of the duodenum to two-thirds along transverse colon.
* HINDGUT– Distal third of transverse colon to the rectum
--\> each part has own supply
55
Where does the esophagus pass the diaphragm?
Which important nerve trunks are associated with it?
Passes it at T10
--\> diaphragm contributes to the lower oesophageal sphincter
Anterior+ posterior vagal trunks are associated with it
56
How is the muscular ring in the stomach called which prevents backflow of chyme from the duodenum?
It is called the pyloric sphincter
57
By which vessel is the Foregut supplied?
The foregut is supplied by the Coeliac trunk
58
In what sections can the duodenum be subdivided?
1. Superior part
2. Descending part
3. Inferior part
4. Ascending part
59
What is important about the superior part of the duodenum?
Fist two centimetres: DUodenal Cap/Apulla ---\> common place for ulcers to occur
It passes anteriorly to bild duct , gastroduondenal artery, portal vein and IVC
60
What is important about the descending part of the duodenum?
Contains major duodenal papilla --\> where the pancreatic duct enters the duodenum
61
What is important about the inferior part of the duodenum?
Largest part, crosses IVC and Aorta (lie posteriorly)
Anteriorly Mesenteric artery and vein
62
What is important about the ascending part of the duodenum?
It terminates at duodenojejunal flexure and passes left of aorta
63
How can you distinguish between the jejunum and the ileum?
Jejenum(A): mucosal folds : pilcae circulares
also: less prominent arterial arcades and longer vasa recta than ileum (B)
64
In which quadrant of the abdomen can the jejenum be found
proximal two fifth
in left upper quadrant of abdomen
65
In which quadrant of the abdomen can the iliac be found?
Distal three-fifth of the small intestine
Found in the right lower quadrant of the abdomen
66
How can you differentiate between the large intesine and the small intestine?
Large intestine
* has mostly a larger diameter (though not reliable)
* accumulation of fat covering ---\> **omental** **apendicies**
* ribbons of longitudinal muscle ---\> **taeniae** **coli**
* saculation/segmentation of wall --\> **haustra of** **coli**
67
Name the eight different parts of the colon
68
Which major artery supplies the midgut?
Branches of the superior mesenteric artery
69
Which artery supplies the hindgut?
The inferior mesenteric artery
70
What are the anterior branches of the abdominal aorta?
1. Celiac trunk
2. Superior mesentery artery
3. Inferior mesenteric artery
71
Which arteries supply the stomach with blood?
* Left gastric artery from celiac trunk
* right gastric artery from hepatic artery proper
* right and left gastro-omental arteries (from right: gastroduodenal from common hepatic, left splenic)
* Posterior gastric artery from splenic artery (not always present)
--\> All branches from the caeliac trunk!
72
How is the small intestine supplied with blood?
Duodenum:
* Branches of gastroduodenal artery
* Branches of superior mesenteric artery
Jejeum
* Jejunal arteries form superior mesenteric arteries
Ileum:
* Ilial arteries from superior mesenteric artery and
* ileal branch from ileocoliac artery
73
How are the cecum and appendix supplied with blood?
Via branches of superior mesenteric artery (branches of ileocolic artery)
74
Which vessel supplied the cecum and appendix with blood?
Branches from the ileocolic atery (a branch of the superior mesenteric artery)
75
How does the parietal peritoneum and visceral peritoneum differ in pain sensation?
Parietal: localised pain
Visceral: dull, referred pain
76
Which important arterys are branche of the caeliac trunk?
Left gastric artery (smallest branch)
Splenic artery (largest branch)
Common hepatic artery
77
What is meant by the bare area of the liver?
The are where the liver is not covered in visceral peritoneum because it fused in development
--\> Has direct contact to diaphragm
78
In which two surfaces can the liver be subevided?
It can be **subdivided** in the Diaphragmatic (anterior, superior and posterior surface)
And in the **visceral surface** (inferior)
79
Which recesses are associated with the diaphragmatic surface of the liver? Where are they located?
* **Subphrenic recess** (superior, separates diaphragmatic surface from the diaphragm). It is divided by the falciform ligament in right and left areas
* **Hepatorenal** **recess --\>** **part** **of the peritoneal cavity** (between the liver, and right kidney(suprarenal gland))
80
Was ist ein Recessus? (Recess)
Mit einem Recessus (lateinisch, maskulin, Plural Recessūs mit langem u, von re~ „zurück~“ und cedere „weichen“, „gehen“) wird in der Anatomie das „Zurückgehen“ einer Struktur oder ihre Einbiegung, Vertiefung, ihr Winkel, ihre Tasche oder Nische bezeichnet.
81
Which structures relate to the visceral surface of the liver?
It is covered in visceral peritoneum except in the fossa for the gallbladder and it is associated with
* esophagus
* right anterior oart of stomach
* superior part of duodenum
* lesser omentum
* gallbladder
* rigth colic flexure
* right transverse colon
* Right kindney + suprarenal gland
82
What structure in the liver serves as a point of entry into the liver for the hepatic arteries and portal veins?
The porta hepatis
83
Which associated ligaments surround the liver?
* The falciform ligament (separeates two lobes, attaches it to anterior abdominal wall)
* Connection to the stomacch (hepatogastric ligament)
* Connection to the duodenum (hepatoduodenal ligament)
* Connection to diaphragm (left and right triangular ligaments + anterior and posterior coronary ligaments)
*
84
Where are the quadrate and caudate lobe of the liver located? Where do they structurally and functionally belong to?
Structure: Both derived from right hepatic lobe
But
* The **quadrate lobe** is positioned anteriorly + functionally related to the left lobe of the liver
* The **Caudate lobe** is positioned posteriorly and functionally separate to both lobes of liver
(Picture= inferior view)
85
Name the different parts of the gall bladder
86
What is the embryological origin of the spleen? (Where does it develop)?
It develops in the dorsal mesentery as part of the vascular system
87
How would you describe the position of the spleen in adults?
(Position + relations)
It can be found in the are of rib IX to rib X
It is surrounded by visceral peritoneum except for the hilum of the spleen
Connected to:
* the greater curvature of the stomach (by gastrosplenic ligament, containing short gastric and gastro-omental vessels)
* Left kidney by a splenorenal ligament (contains splenic vessels)
---\> Both are part of greater omentum
88
What is the blood supply of the spleen?
It is supplied by splenic artery, the largest branch of the celiac trunk
89
Which structures lie retroperitoneally in the abdomen?
Which of them had originally a mesentey?
–Kidneys & ureters
–Suprarenal glands
–Aorta/Inferior vena cava
–Nerves: lumbar plexus, sympathetic trunk
–Oesophagus
–Rectum
–Duodenum (except the first part) \*
–Pancreas (tail is INTRAperitoneal) \*
–Colon (ascending and descending only)\*
\*These organs originally had a mesentery, then became secondarily retroperitoneal when the mesentery fused with the body wall
90
Draw/imagine the organisation of the great abdominal vessels, pancreas, duodenum, kindeys and spleen to one another
91
Describe the relationships of the liver and the jejunum to the kidneys
Note the relations of both kidneys, remembering that the liver is anterior to the upper part of the R kidney and the jejunum to the lower part of the L kidney
92
93
By which type of Nerves are the organs supplied?
Why is this relevant?
The organs are only supplied by Autonomic Nervous system --\> SNS + PNS
This does not allow localised sensation but results into referred pain
94
How are the autonomic nerves supplying the organs normally organised?
They are organised as plexuses surrounding the aorta which is named according to the associated blood vessels
95
Where do the parasympathetic nerves supplying the arise from?
Parasympathetic brain stem (cranial nerve, III, VII, IX,, X=vagus) and S2-4
96
What are the main sympathetic nerves that supply the abdominal viscera and where do they arise from?
97
What is the function of the affarent nerves in the abdomen?
Afferent nerves:
* Sympathetic:pain
* Parasympathetic:specific functional sensation, e.g.stretch
98
What is the function of the efferent nerves of the abdominal viscera?
Efferent nerves:
* motor to smooth muscle
* secretomotorto glands
99
In which dermatome is pain from the foregut felt? Where is if felt?
It is felt in the Supergastric region in dermatome T7/T8
100
In which region is referred pain from the midgut felt?
What is the dermatome?
it is felt in the umbilical region (T10 dermatome)
101
In which region is pain from the hindgut felt?
What is the dermatome?
It is felt in the hypogastric region in dermatome T12/ L1-L2
102
Which three pelvic bones are fused?
When do they fuse?
How is the site of fusion called?
The three pelvic bones are the **ilium,** the **Pubis**, and the **ischium**
They are joint by cartilage at birth and fust together at the age of 18/19
The site of fusion is called **Acetabulum**
103
Label the missing Part
Sacrum
104
Posterior superior iliac spine
105
106
Ischial spine
107
108
What are the bony parts of the pelvic wall?
The pelvic bones, the sacrum and the coccyx.
109
110
Differentiate between the true and the false pelvis
The false pelvis is essentially the bony part which is still in the abdominal cavity whereas the parts of the true pelvis have an inlet and an outlet
111
What is the function of the sacrospinous and sacrotuberous ligament?
They stabilize the sacrum on the pelvic bones by **restricting upwards movements** of the inferior part of the sacrum
They also convert notches into foramina: **greater sciatic foramina, lesser sciatic foramina**
112
What are the structures limiting the pelvic outlet?
Pubic body, Pubic arches, coccyx and the sacrotuberous ligament
113
Which muscle covers most of the pelvic bone facing the pelvic cavity?
obturator internus muscle and its fascia
114
Which two pelvic muscles are attached to the medial surface of the greater trochanter of femur?
What is their function?
The obturator internus muscle and piriformis internus muscle
--\> They are responsible for hip movements
115
116
117
118
119
120
What is the pelvic diaphragm?
What deos it consist of?
What does it do?
What is its nerve supply?
The pelvic diaphragm consists of a bowl-like pair of skeletal muscles: Levatorani, which support the pelvic organs (bladder, cervix/uterus and rectum)
Nerve supply: Pudendal(S2-4) & directly by S4
121
How many openings are there in the pelvic diaphragm?
There are 2 (in men) and 3 (in women) openings of the pelvic diaphragm
122
Which structures lies inferior to the pelvic diaphragm? Which structures does it hold?
Below the diaphragm is the **perineum,** containing voluntary sphincters and external genitalia
123
How are the pelvic organs supplied with blood?
Where do bifurcations occur?
124
Which Sex does this pelvis belong to?
What is the muscle and ints function shown in green?
I is (probably) a female pelvis
And themuscle in levator ani
Bildet beckenbodem, hebt Anus bei Defäkation an
125
What is the main functional sphincter of the Rectum and anal canal?
The main functional sphincter is pubo-rectalissling of levator ani
126
What does the internal iliac artery supply?
It supplies all the organs in the pelvis (exept ovaries)B
127
What are the structural differences between the male and the female pelvic bone?
Male:
* Heart-shaped inlet
* Steep sub-pubic angle (50-60°)
Female
* Round inlet
* Pubic angle 80-90°
128
How can you determine the anatomical position of the pelvis?
Which two structures are in one plane at this angle?
It is tilted backward so that ASIS and pubic tubercle are in the same plane
129
What are the contents of the male pelvis that are not present in the female?
•Prostate, ductus deferens, seminal vesicles, bulbourethral glands
130
What structures in the male pelvis can be felt on a digital rectal examination(DRE) of a healthy man?
The **prostate gland and seminal vesicles** can be felt and the
131
What are the seminal vesicles?
Where are they located?
Glands that are present in males. They secrete a fluid that partly composes the semen.
It is situated between the bladder and the rectum and fuses with the ductus deference to form the **ejaculatory duct**
132
What are the ductus deference?
Explain their course
Ductus deferens from testis passes through the **inguinal canal,** then **over, and behind ureter** to **enter the urethra** through the **prostate**
133
What is the venous and arterial blood supply of the testes?
Arterial supply:
* Gonadal arteries
Venous supply:
* Right testis: drains directly into the IVC
* Left testis: drains into the left renal vein
134
Which structures have openings in the prostate gland?
**Prostatic utricle** (=in women: uterus)
* is a small indentation in the prostatic urethra
**Ejaculatory ducts**
* fused from seminal vesicle and ductus deferens and ampulla
**Openings of prostate glands**
135
How are the parts of the urethra in males called?
What is the narrowest part of the male urethra?
Normally the opening (External urethral orifice) is the narrowest part of the urethra in males
136
Which artery supplies the Bladder and ductus deference?
Superior vesical artery
* Branch of the internal iliac artery
137
Which artery supplies the prostate, bladder & ductus deferens
The inferior vesical artery
138
Which artery supplies the prostate gland?
The prostatic branch of the inferior vesical artery
139
What are the boundaries of the Perineum?
How can it be subdivided?
Diamond-shaped area between **pubic symphysis,** **ischial tuberosities** and **coccyx**
It can be subdivided into anterior and posterior triangles (separated by the perineal body)
140
What is the perineal membrane? Where is it located?
It is a **thick triangular fascial structure** attached to **pubic** **arch.**
Posteriorly: free margin
Anteriorly a small gap.
141
What is the superficial perineal pouch?
Which structures does it contain in males and females?
It holds the erectile tissue of the penis which can be subdevided into
* 2 lateral erectile tissue mass: **corpora cavernosal**
* 1 medial erectile tissue mass (contains urethra) **corpus** **spongiosum**
142
What is the deep perineal pouch?
Which structures does it contain?
It is the anatomic space enclosed in part by the perineum, and located **superior to the perineal membrane**
It contains Muscles, the **Bulbourethral glands,** vagina and urethra
143
What is the blood supply to the rectum and anal canal?
it recieves blood from Branches of the **inferior mesenteric artery** and internal **iliac artery**
144
What is the Ischioanal fossa?
What is its function?
What does it contain?
1. It is the fat-filled space in the anal triangle
2. It allows recto-anal and vaginal expansion when needed
3. In their lateral wall is the pudendal neuro-vascular bundle supplying the perineum including the lower rectum.
145
Summarise the blood supply to the penis
Main **Arterial** supply **from internal pudendal artery** from internal iliac artery splits into
* Deep artery (corpora cavernosa)
* Dorsal artery (skin and connective tissue)
* Artery of the bulb (bulb + corpus spongiosum inkl. glans and urethra)
**Venous drainage:**
* Dorsal vein
146
Summarise the nerve supply of the pelvic contents
* •Pelvic contents supplied by a**utonomic nerves only**
* •**Sympathetic** from lower thoracic and upper lumbar (T10 - L2) segments via hypogastric plexus
* •**Parasympathetic** from S2-4outflow
* •Pelvic sensation is visceral and poorly localised - pain is **referred** to suprapubic region and perineum
147
Where is pain from the pelvic contents often referred to?
pain is referred to suprapubic region and perineum
148
Where does the pudendal nerve originates from? (somatic supply)
Sacral outflow from S2-S4
149
Explain the route of the pudodendal nerve in the pelvis
* Originates S2-S4
* passes briefly from pelvis to buttock, thus passing behind the fibrous posterior edge of Levatorani(the sacrospinous ligament.
* It passes forward below Levator ani, first in the lateral wall of the ischioanalfossa(posterior perineum)
* then branching to anterior perineum, penis/clitoris and scrotum/vulva.
150
What is the pelvic diaphragm mainly formed by?
The pelvic diaphragm (pelvic floor) is mainly formed by the levator ani
151
What is the perineal body?
pyramidal fibromuscular mass in the middle line of the perineum at the junction between the urogenital triangle and the anal triangle.
--\> surface landmark
152
How big is the uterus?
How long is the vagina?
What are the measurements of a normal cervix?
The uterus sis about 8-9cm long
The vagina about 10cm
and a normal cervix is about 2,5cm long
153
What is the vulva vestibule? What are its other names?
Also called vestibule of vagina
* part of the vulva between the labia minora
* urethral opening and vaginal openings are in this region
154
What is the name of the space anteriorly of the uterus between the uterus and the bladder?
What is the lining of this pouch?
It is called the vesico-uterine pouch, which is lined by peritoneum
155
How is the space posteriorly of the uterus between the uterus and the rectum called? (Two names)
What is its lining and clinical relevance
This is the **recto-uterine pouch** or **pouch of Douglas**
* Abdominal abscesses/ fluid often accumulates in there --\> can be used to drain this fluid
156
How is the fold of peritoneum lining the uterus auterineine tubule in the female pelvis called?
It is the broad ligament
157
What is the broad ligament?
Describe its position and its contents
It is a fold of peritoneum in the female pelvis lining the uterus and uterine tube (coronal plane)
**It contains:**
* Uterine tubes
* Ovaries are suspended (not completely enveolped) by part of borad ligament called mesovarium
158
How do the ovarian vessels, nerves and lymphatics get to the ovaries?
Which structure do they pass through?
They are covered by a fold called the **suspensory ligament of the ovary (infundibulopelvic ligament)**
## Footnote
They enter the superior pole of the ovary from a lateral position
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What is the inferior pole of the ovary attached to?
Which route does it take?
It is attached to the **ligament of the ovary**
which runs towards the uterus and continues anterolaterally as the round ligament of the uterus
161
Explain the course of the round ligament of the uterus
The round ligament of the uterus
1. passes over pelvic inlet
2. into the deep inguinal ring
3. through the inguinal canal
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Which structures support the cervix passively and dynamically?
What is their function?
Their function is to hold the cervix in place--\> uterus can't prolapse into the vagina
## Footnote
Passive support (three ligaments formed by the same fascia
(s. Picture)
Active support by the pelvic floor muscles
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Name the labelles parts of the uterus
164
What is a hysterectomy?
Which structures are at risk (and why)?
A hysterctomy is the surgical removal of the uterus
It is important to identify the uterine arteries (which is removed) and ureters to prevent the accidental tying off of **ureters**
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Which route allows in females external pathogens to enter the peritoneal cavity?
Via the reproductive organs (vagina, uterus, uterine tubes, ovary)
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Which epithelium lines the cervical canal?
It is lines by secreting columnar epithelium
169
Which epithelium lines the vaginal surface of the cervix?
Stratified squamous non-keratinising epithelium
170
Which part of the vaginal wall does the cervix project to? Why?
It projects into the anterior vaginal wall because of the differnet angles of vagina/uterus and cervix
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What are the angles called that emerge because of the differently tilted Uterus, cervix, and vagina?
1. The angle of anteflexion (uterus/cervix)
2. Angle of anteversion (vagina/cervix)
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What is the spaces called that emerge because the cervix is tilted and goes on into the vaginal canal?
Explain how they differ from one another
Different Fornix (es) emerge with differnt depths
1. Posterior fornix=deepest
2. Lateral fornix
3. Anterior fornix (shallowest)
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How is the enlarged internal end of the vagina called?
It is called the vaginal vault
174
Explain the relationship of the urethra and the vagina
The urethra lies anteriorly to the vagina and is often embedded/fused with the anterior vaginal wall
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Which structures can be felt through the vaginal walls?
* •Cervix
* •Ischial spine
* •Sacral promontory
* •Uterine artery pulse (lateral fornix)
* •Ovary
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What is the main blood supply to the pelvis and perineum?
Which structures does is supply?
The internal iliac artery on each side
it supplies
* most of the pelvic viscera
* pelvic wall and floor
* sturctures in the perinuem (inkl. erictile tissue and clitoris)
177
By which blood vessel are the ovaries supplied?
Explain the lymph drainage of the ovaries
By the ovarian arteries, arising from the abdominal aorta
## Footnote
Lymph drainage goes to the abdominal/renal region
178
Which branches of the internal iliac artery supplied the pelvic visera? (female)
Main branches to pelvic viscera are
* superior vesical artery
* uterine artery
* middle rectal artery
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Which branches of the internal iliac artery supply the pelvic wall?
Walls of pelvis supplied by
* sacral
* gluteal
* obturator branches
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Which branch of the internal iliac artery supplied the perineum and recto-anal region in females?
**Pudendal artery** supplies perineum and recto-anal region (via inferior rectal branch)
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What is the main blood supply to the uterus? Explain its route
What happens to it during pregnancy?
Uterine artery (branch of internal iliac artery)
--\> Runs medially/anteriorly over broad ligament, crosses the ureter gets to the base of the uterus
--\> ascends laterally and supplies it with blood
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What does the descending branch of the uterine artery supply?
Is supplies the vagina
183
What is the relationship between the uterine artery and the ovarian artery?
the uterine artery anastomoses with the ovarian artery
184
What are the surface landmarks of the female perineum?
Just like the male:
Pubis symphysis,
two lateral ischial tuberosity
and perineal body,
end of the coccyx
185
Which deep perineal structures are only present in the female, not in the male?
186
Compare the strengh of the external and internal urethral spincter in male and femal and its clinical significance
In females the internal urethral sphincter (IUS) is not well developed.
The external urinary sphincter is more intricate in women than in men.
EUS is crucial for maintaining urinary continence in women.
187
What are the superficial perineal pouch in females?
* **Median erectile tissue mass** (corpus spongiosum in males) divides around the vestibule to form **vestibular bulbs.** The **glans of** **clitoris** is derived from this.
* **•Lateral erectile tissue masses**(corpora cavernosa in males) Paired cylinders, attached to ischiopubic rami. Forming the **body of** **clitoris**
* --\> Surrounded by skeletal muscle
188
What are the bulbs of vesibule in females?
Erectile stissue at the vaginal opeing (under labia major), form the glans of the klitoris (corpus spongiosum in men)
189
What is the homologous structure of the prostate in the female?
Where are they located?
It is the Skene's gland --\> Openings next to the urethral opening
190
What is the paraurethral gland in females?
Greater vestibular gland --\> open into/next to opening of vagina
191
Where do the sympathetic nerves that supply the pelvic viscera derive from?
•Sympathetic from lower thoracic and upper lumbar segments T10 - L2 via hypogastric plexus
192
Where do the parasympathetic nerves that supply the pelvis derive from?
Parasympathetic from S2-4 outflow
193
Where is pain from the pelvic region referred to?
•Pelvic sensation is visceral and poorly localised - pain referred to suprapubic region and perineum
194
Which nerves supplies the somatic/perineal part of the pelvis?
The pudendal nerve from S2-S4
195
Into which lymph node do most pelvic organs drain to?
•Pelvic organs drain mainly to external and internal iliac nodes (around the arteries)
196
Which lymph nodes do ovaries and testes drain?
•Ovary and testis drain to para-aortic nodes (near kidney)
197
Which lymph nodes do structures from the perineum and external genitalia drain to?
•Perineum(including anal canal) and external genitalia drain to **superficial inguinal nodes** (subcutaneous below inguinal ligament).
198
Which two major branches of a big vessel supply the ascending colon?
All branches of the superior mesenteric artery:
* Ileocolic artery
* Right colic artery
199
Which vessels supply the transverse colon with blood?
Right colic artery (superior mesenteric)
Middle colic artery (superior mesenteric)
Left colic artery (**inferior** mesenteric)
200
Summarise the vascular supply to the descending colon
Left colic artery (inferior mesenteric)
201
Which vessel supply the sigmoid colon?
Sigmoidal arteries (inferioro mesenteric)
202
Which vessels supplys the rectum and anal canal?
Superior rectal artery (inferior mesenteric)
middle rectal artery and inferior rectal artery (from internal iliac artery)
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204
205
206
207
208
209
210
211
212
213
214
A= Greater sciatic foramen
B= Lesser sciatic foramen
215
Which arteries form the hepatic portal vein?
Where do they join?
Which role does the inferior mesenteric vein play?
It is formed by the superior mesenteric vein and splenic vein (splenic vein is joined by the inferior mesenteric vein)
They join behind the pancreas
216
At which level does the aorta bifurcate?
At level L4
217
Nerves from sympathetic ganglia does the greater splanic nerve comprises nerves?
What does it supply?
From T5-T9
It normally supplies the foregut
218
Nerves from which sympathetic ganglia form the lesser splenic nerve?
What does it supply?
Nerve from level T10-T11 join to supply the midgut
219
Where does the least splanic nerve originate from?
What does it supply?
T12
It supplies the renal plexus
220
What are the main muscles that form the pelvic diaphragm
Levator ani
* Iliococcygeus muscle
* Pubococcygeus muscle
* Puborectalis muscle
Obturator internus muscle
Piriformis msucle
Coccygeous muscle
221
Explain the route of the Levator Ani
In which three muscles can it be separated?
Origin: each side of the pelvic wall
Go medially and inferiorly, join together at the midline to form the anococcygeal ligament)
1. Pubococcygeus (body of the pubis to coccyx)
2. Puborectalis (Pubis forming perineal flexure)
3. Iliococcygeus (from the fascia of obturator internus around the ring to the other side of fascia obturator internus)
222
To which part of the pelvic diaphragm does the coccygeus muscle contribute?
Explain their route
To the Posterior part of the pelvic diaphragm (attached to the coccyx, run to tips of the ischial spine)
223
Which muscle covers the obturator membrane?
Obturator internus muscle
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227
What is the function of this muscle?
It **flexes the lumbar vertebral** column
Fixes 12th rib during inspiration
Both quadratus lumborum= extend lumber vertebras
228
What is the function of this muscle?
From iliac fossa to HIp
--\> Flexor of hip
229
Psoas Major = Flexor of hip
230
