Anatomy Abdomen Flashcards
What are the skeletal components of the abdominal wall?
- Five Lumbar vertebrae
- Superior expanded parts of pelvic bones
- costal margin rib XII, end of rib XI, xiphoid process
What is the main muscle in the anterior abdominal wall?
Rectus Abdominis
+ Rectus sheath
What is the rectus sheath?
A sheath which surrounds rectus abdominis
–> built by “Sehnenplatten” (
–< muss ergänzt werden!
Intraperitoneal
structures that are suspended from abdominal wall by mesenteries
Retroperitoneal
Structures not suspended in the abdominal wall but lie between the parietal peritoneum and abdominal wall
(e.g. kidney and ureters)
Explain the nine-region pattern of the abdominal wall (Borders, planes)
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)
Name the nine regions of the abdomen
What is the superficial fascia?
A layer of fatty, subcutaneous connective tissue of the abdominal wall
Linea Alba:
What is the function of the anterolateral muscles in the abdominal wall?
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
Which one is the most superficial anterolateral abdominal muscle?
Where is it atached to?
Attached to lower 8 ribs
Free ends –> turns into aponeurosis (linea alba and inguinal ligament)
In which direction does the external oblique abdominal muscles pass?
Inferomedial direction
Aponeurotic component covers the anterior part of the abdominal wall forming linea alba
In which direction do muscle fibers of the internal oblique muscles pass?
Superior medial direction
Aponeurosis also blends into linea alba
How it the deepest layer of abdominal muscles called?
In which direction does it pass?
Transversus abdominus
Across abdomen, blending into linea alba
What is the transversalis fascia?
Fascia deep to transversus abdominis
–> basically forms fascia which is thicker and thinner at some point but connects through whole abdominal cavity and back
Widens and thins from as ascending from pubic synthesis to costal margin
Paired muscle, separated by linea alba
How are the abdominal muscels innervated?
Anterior rami of lower six thoracic spinal nerves (T7-T12)
L1 for Internal oblique and Transversus abdominis)
What is the rectus sheath and how does it change over the different spinal levels?
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)
What is the extraperitoneal fascia?
What does it separate?
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
What is the peritoneum?
How can you classify the peritoneum?
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
Explain the route of cutaneous nerve innervation of the abdomen
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
By which nerve is the region around the umbillicus supplied?
T10
By which nerve is the inguinal ligament supplied?
L1
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
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)
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
In which two segments can the superficial fascia be devided?
Campers fascia: Superficial fatty fascia (varies in thickness)
Scarpas fascia: Deeper, thin and membranous
Summarise the layers (from superficial to deep) you cut when making an incision into the abdominal wall.
- Skin
- Superficial fascia: Campers fascia, Scarpans fascia
- Muscles/Aponeuroses
- Transversalis fascia
- Extraperitoneal fascia
- Peritoneum
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)
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
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
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
What forms the,, bottom”, floor of the inguinal canal?
What is the most inferior border of the inguinal canal?
The inguinal ligament
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
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
What forms the posterior wall of the inguinal canal?
Transverse fascia
Medial third: reinforced by conjoint tendon
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
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
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
Direct: Direktes Durchtreten des Bruchsacks durch die Bauchwand ohne Beziehung zum Funiculus spermaticus
How long is the inguinal canal in adult males?
About 4 cm
Which type of hernia is more common in males than in females?
Indirect inguinal hernia
In females: most of the time a femoral hernia
In which area do most direct inguinal hernias occur?
In the Hesselbachs triangle
Boundaries:
Lateral: inferior epigastric artery
Medially: rectus abdominis
Interior: Inguinal ligament
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
What is the peritoneum?
Thin membrane (simple squamous) that lines walls of the abdominal cavity and many viscera
What are mesenteries
Folds of the peritoneum which contain abdominal organs
–> Components of the GI tract are suspended in peritoneal reflections
What is the peritoneal cavity?
The space enclosed by the two layers of the peritoneum
How can the peritoneal cavity be subdivided?
Into
- greater sac –> most of the space from the diaphragm to pelvic cavity
- Omental bursa: subdivision posterior to stomach and liver
—> are continuous with each other
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
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 + right and left gastro-omental vessels just inferiorly to the stomach
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
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
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
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
How is the muscular ring in the stomach called which prevents backflow of chyme from the duodenum?
It is called the pyloric sphincter
By which vessel is the Foregut supplied?
The foregut is supplied by the Coeliac trunk
In what sections can the duodenum be subdivided?
- Superior part
- Descending part
- Inferior part
- Ascending part
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
What is important about the descending part of the duodenum?
Contains major duodenal papilla –> where the pancreatic duct enters the duodenum
What is important about the inferior part of the duodenum?
Largest part, crosses IVC and Aorta (lie posteriorly)
Anteriorly Mesenteric artery and vein
What is important about the ascending part of the duodenum?
It terminates at duodenojejunal flexure and passes left of aorta
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)
In which quadrant of the abdomen can the jejenum be found
proximal two fifth
in left upper quadrant of abdomen
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
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
Name the eight different parts of the colon
Which major artery supplies the midgut?
Branches of the superior mesenteric artery
Which artery supplies the hindgut?
The inferior mesenteric artery
What are the anterior branches of the abdominal aorta?
- Celiac trunk
- Superior mesentery artery
- Inferior mesenteric artery
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!
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
How are the cecum and appendix supplied with blood?
Via branches of superior mesenteric artery (branches of ileocolic artery)
Which vessel supplied the cecum and appendix with blood?
Branches from the ileocolic atery (a branch of the superior mesenteric artery)
How does the parietal peritoneum and visceral peritoneum differ in pain sensation?
Parietal: localised pain
Visceral: dull, referred pain
Which important arterys are branche of the caeliac trunk?
Left gastric artery (smallest branch)
Splenic artery (largest branch)
Common hepatic artery
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
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)
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))
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.
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
What structure in the liver serves as a point of entry into the liver for the hepatic arteries and portal veins?
The porta hepatis
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)
*
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)
Name the different parts of the gall bladder
What is the embryological origin of the spleen? (Where does it develop)?
It develops in the dorsal mesentery as part of the vascular system
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
What is the blood supply of the spleen?
It is supplied by splenic artery, the largest branch of the celiac trunk
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
Draw/imagine the organisation of the great abdominal vessels, pancreas, duodenum, kindeys and spleen to one another
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
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
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
Where do the parasympathetic nerves supplying the arise from?
Parasympathetic brain stem (cranial nerve, III, VII, IX,, X=vagus) and S2-4
What are the main sympathetic nerves that supply the abdominal viscera and where do they arise from?
What is the function of the affarent nerves in the abdomen?
Afferent nerves:
- Sympathetic:pain
- Parasympathetic:specific functional sensation, e.g.stretch
What is the function of the efferent nerves of the abdominal viscera?
Efferent nerves:
- motor to smooth muscle
- secretomotorto glands
In which dermatome is pain from the foregut felt? Where is if felt?
It is felt in the Supergastric region in dermatome T7/T8
In which region is referred pain from the midgut felt?
What is the dermatome?
it is felt in the umbilical region (T10 dermatome)
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
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
Label the missing Part
Sacrum
Posterior superior iliac spine
Ischial spine
What are the bony parts of the pelvic wall?
The pelvic bones, the sacrum and the coccyx.
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
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
What are the structures limiting the pelvic outlet?
Pubic body, Pubic arches, coccyx and the sacrotuberous ligament
Which muscle covers most of the pelvic bone facing the pelvic cavity?
obturator internus muscle and its fascia
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
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
How many openings are there in the pelvic diaphragm?
There are 2 (in men) and 3 (in women) openings of the pelvic diaphragm
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
How are the pelvic organs supplied with blood?
Where do bifurcations occur?
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
What is the main functional sphincter of the Rectum and anal canal?
The main functional sphincter is pubo-rectalissling of levator ani
What does the internal iliac artery supply?
It supplies all the organs in the pelvis (exept ovaries)B
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°
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
What are the contents of the male pelvis that are not present in the female?
•Prostate, ductus deferens, seminal vesicles, bulbourethral glands
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
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
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
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
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
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
Which artery supplies the Bladder and ductus deference?
Superior vesical artery
- Branch of the internal iliac artery
Which artery supplies the prostate, bladder & ductus deferens
The inferior vesical artery
Which artery supplies the prostate gland?
The prostatic branch of the inferior vesical artery
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)
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.
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
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
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
What is the Ischioanal fossa?
What is its function?
What does it contain?
- It is the fat-filled space in the anal triangle
- It allows recto-anal and vaginal expansion when needed
- In their lateral wall is the pudendal neuro-vascular bundle supplying the perineum including the lower rectum.
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
Summarise the nerve supply of the pelvic contents
- •Pelvic contents supplied by autonomic 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
Where is pain from the pelvic contents often referred to?
pain is referred to suprapubic region and perineum
Where does the pudendal nerve originates from? (somatic supply)
Sacral outflow from S2-S4
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.
What is the pelvic diaphragm mainly formed by?
The pelvic diaphragm (pelvic floor) is mainly formed by the levator ani
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
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
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
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
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
How is the fold of peritoneum lining the uterus auterineine tubule in the female pelvis called?
It is the broad ligament
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
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)
They enter the superior pole of the ovary from a lateral position
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
Explain the course of the round ligament of the uterus
The round ligament of the uterus
- passes over pelvic inlet
- into the deep inguinal ring
- through the inguinal canal
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
Passive support (three ligaments formed by the same fascia
(s. Picture)
Active support by the pelvic floor muscles
Name the labelles parts of the uterus
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
Which route allows in females external pathogens to enter the peritoneal cavity?
Via the reproductive organs (vagina, uterus, uterine tubes, ovary)
Which epithelium lines the cervical canal?
It is lines by secreting columnar epithelium
Which epithelium lines the vaginal surface of the cervix?
Stratified squamous non-keratinising epithelium
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
What are the angles called that emerge because of the differently tilted Uterus, cervix, and vagina?
- The angle of anteflexion (uterus/cervix)
- Angle of anteversion (vagina/cervix)
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
- Posterior fornix=deepest
- Lateral fornix
- Anterior fornix (shallowest)
How is the enlarged internal end of the vagina called?
It is called the vaginal vault
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
Which structures can be felt through the vaginal walls?
- •Cervix
- •Ischial spine
- •Sacral promontory
- •Uterine artery pulse (lateral fornix)
- •Ovary
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)
By which blood vessel are the ovaries supplied?
Explain the lymph drainage of the ovaries
By the ovarian arteries, arising from the abdominal aorta
Lymph drainage goes to the abdominal/renal region
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
Which branches of the internal iliac artery supply the pelvic wall?
Walls of pelvis supplied by
- sacral
- gluteal
- obturator branches
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)
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
What does the descending branch of the uterine artery supply?
Is supplies the vagina
What is the relationship between the uterine artery and the ovarian artery?
the uterine artery anastomoses with the ovarian artery
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
Which deep perineal structures are only present in the female, not in the male?
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.
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
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)
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
What is the paraurethral gland in females?
Greater vestibular gland –> open into/next to opening of vagina
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
Where do the parasympathetic nerves that supply the pelvis derive from?
Parasympathetic from S2-4 outflow
Where is pain from the pelvic region referred to?
•Pelvic sensation is visceral and poorly localised - pain referred to suprapubic region and perineum
Which nerves supplies the somatic/perineal part of the pelvis?
The pudendal nerve from S2-S4
Into which lymph node do most pelvic organs drain to?
•Pelvic organs drain mainly to external and internal iliac nodes (around the arteries)
Which lymph nodes do ovaries and testes drain?
•Ovary and testis drain to para-aortic nodes (near kidney)
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).
Which two major branches of a big vessel supply the ascending colon?
All branches of the superior mesenteric artery:
- Ileocolic artery
- Right colic artery
Which vessels supply the transverse colon with blood?
Right colic artery (superior mesenteric)
Middle colic artery (superior mesenteric)
Left colic artery (inferior mesenteric)
Summarise the vascular supply to the descending colon
Left colic artery (inferior mesenteric)
Which vessel supply the sigmoid colon?
Sigmoidal arteries (inferioro mesenteric)
Which vessels supplys the rectum and anal canal?
Superior rectal artery (inferior mesenteric)
middle rectal artery and inferior rectal artery (from internal iliac artery)
A= Greater sciatic foramen
B= Lesser sciatic foramen
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
At which level does the aorta bifurcate?
At level L4
Nerves from sympathetic ganglia does the greater splanic nerve comprises nerves?
What does it supply?
From T5-T9
It normally supplies the foregut
Nerves from which sympathetic ganglia form the lesser splenic nerve?
What does it supply?
Nerve from level T10-T11 join to supply the midgut
Where does the least splanic nerve originate from?
What does it supply?
T12
It supplies the renal plexus
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
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)
- Pubococcygeus (body of the pubis to coccyx)
- Puborectalis (Pubis forming perineal flexure)
- Iliococcygeus (from the fascia of obturator internus around the ring to the other side of fascia obturator internus)
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)
Which muscle covers the obturator membrane?
Obturator internus muscle
What is the function of this muscle?
It flexes the lumbar vertebral column
Fixes 12th rib during inspiration
Both quadratus lumborum= extend lumber vertebras
What is the function of this muscle?
From iliac fossa to HIp
–> Flexor of hip
Psoas Major = Flexor of hip
