Anatomy / Histology Flashcards
Inguinal (Hessle Bach’s) triangle boundaries:
RIP
-Rectus abdominis
- inf epigastric artery
- poupart’s (inguinal lig)
Anterior and posterior Endopelvic Fascia called
Cervical ligament
Its anterior thickened part called: pubocervical lig
Posterior: Uterosacral lig
Cardinal ligament AkA
Transverse cervical ligament or Mackenrodt’s ligament
Origin of cardinal lig and its insertion:
Origin: from the isthmus of the cervix
Insertion: white line “thickened lower part obturator fascia from symphysis pubis to ischial spine”
3 structures originate from Cornu of the uterus:
From most anterior to post:
Round lig>fallop tube> utero-ovarian lig
From superior to inferior:
The round lig and utero-ovarian lig at the same level
While the Fallopian tube is the highest
Endometrial ca at the Cornu of uterus which LNs would be involved:
Inguinal LNs
Round lig AKA
Ligamentum teres
The artery of the round ligament of the uterus AKA
Sampson’s artery is a branch of the inferior epigastric artery It constitutes an anastomosis of the uterine artery and ovarian artery.[
Embryological origin of Round lig
Gabernaculum
What are the Avascular spaces in the pelvic cavity:
8 spaces (4 midlines and 4 lateral):
Lateral spaces:
1) pared pararectal
2) para vesical spaces
(Both used to ligate hypogastric)
Midline spaces:
1) space of retzius (or cave of retzius/ retropubic space) prevesical
2) vesicouterine space
3) rectouterine space
4) retrorectal space
What are the boundaries of space of retzius (or cave of retzius/ retropubic space)
Ant: rectus abdominis lined by Transverse sheath
Post: peritoneum of the bladder
Inf: pubovesical or pubocervical lig or vesicocervical fascia (thickened part of superior levator ani fascia)
Lateral: superior vesical a. Or obliterated hypogastric a. Or obliterated medial umbilical lig.
Name the pelvic joints:
4 joints:
-Symphysis pubis (fibrocart joint)
- sacroiliac joint (Lt & Rt) (synovial joints)
- sacrococcygeal joint.(synovial hinge joint)
The boundaries of pelvic brim or inlet:
From post - ant, are:
- Sacral promontory
- sacral Alae
- sacroiliac joint
- illiopectineal lines
- illiopectineal eminence
- upper border of superior pubic rami
- pubic tubercle
- pubic crest
- upper border of pubic symphysis
The true pelvis can be divided into three parts:
1- pelvic inlet lies @ level of pelvic brim
2- pelvic cavity lies @ level of ischial spine
3- pelvic outlet lies @ level of ischial tuberosity
The most common variety of pelvic shapes:
Gynecoid pelvis (50%)
the best shape of the pelvic inlet for normal delivery.
How to measure Angle of inclination ? How much degree?
Can be measured - Radiographically- by measuring the angle btw L5 and inlet plane -180= 55 degree
What are the 3 clinically important pelvic outlet diameters ? How much measured ?
- AP diameter: from lower border of symphysis pubis to to the top of coccyx (11.5-13.5 cm)
- Transverse or Intertuberous: btw inner borders of ischial tuberosities ( 11 cm)
- subpubic angle: btw two descending pubic rami measures: 90-100 degree
Pelvic outlet boundaries:
Anteriorly anterior border of symphysis pubis, pubic arch, laterally ischial tuberosities, posterolaterally is the inferior margin of the sacrotuberous ligaments, posteriorly tip of coccyx.
Rectovaginal septum (fascia of Otto) boundaries:
Ant: vaginal
Post: rectum
Caudal: perineal body
Cephalat: cul- de- sac
Laterally: uterosacral lig and ?ureter? (as far as I know that lateral boundaries is yet poorly defined)
Presacral fascia boundaries:
Cephalad:bifurcation of aorta
Anterior: rectum
Posterior: sacrum
Laterally: internal iliac artery
Presacral space importance: hyposgastric
Highly important structure pass by:
- sympathetic trunk collecting in ganglion impar (innervate rectum and bladder)
- superior hypogastric plexus (T10-L1)
- 2 inferior hyposgastric plexus
Anterior fontanelle, what is the forming sutures ? And what is it’s diameters ? When it is close ?
Formed by joining of the four sutures, anteriorly frontal, posteriorly sagital and laterally coronal (diamond shaped)
AP & Transverse diameters measure 3 cm each
Ossified at 18 months after birth< pathological if not after 24 months
Posterior fontanelle, what are the forming sutures? How much Measures ? When it is ossify ?
Formed by junction of three suture lines sagital anteriorly and lambdoid laterally (Triangular shaped)
Measures 1.2x1.2 cm
Ossify 2-3 months of birth
2 Para-vesical space boundaries:
retroperitoneal space anterior and superior to the pararectal space. It is enclosed medially by the bladder, laterally by the pelvic walls, and inferiorly by the uterine artery. The pararectal and paravesical space can mutually communicate with each other, and also with the prevesical space. Dissection of these spaces ensures easy and complete removal of the uterus and its attachments during radical hysterectomy.
Medial: obliterated medial umbilical a.(superior Vesical a)
The only lateral branch of the internal iliac artery is the obturator artery, which lies in the lateral paravesical space
2 pararectal spaces boundaries:
Med: rectum and ureter
Lat: internal iliac a.
Ant: uterine artery and cardinal lig
Post: sacrum
Vulva innervation:
PIG
Pudendal n./ Post. Gluteal n.of the thigh
Illioinguinal n. (L1)
Genitofemoral n.
It’s injury led to parasthesia in the vulva
Decidua. Composed of 3 layers:
-zona compacta
- zona spingiosa
- zona basalis
(Blastocyst implanted only in zona compacta due to presence of metobuach layer)
( the decidua that lies opposite to site of implantation called decidua Vera or Partialis)
Medial aspect of the thigh innervation:
FIGO
Femoral n.
Illioinguinal n.
Genitofemoral n.
Obturator n.
Pneumonic
The part of decidua zona compact that covers the blastocyst it’s called ………
Decidua capsularis
contents of the deep perineal pouch:
- lower part of vagina, proximal portion of urethra in female / membranous urethra in male
- ext. urethral sphincter (sphincter urethrae)
- deep transverse perineal m.
- pudendal n./a.
bleeding if this space (vaginal hematoma) led to excruciating pain and urine retention.
Associations with unicornuate uterus
renal abnormalities
renal anomalies are more commonly associated with a unicornuate uterus than with other Müllerian duct anomalies and are present in 40% of cases, e.g. renal agenesis
the renal anomaly is always ipsilateral to the rudimentary horn
cryptomenorrhea within endometrium containing rudimentary horn that does not communicate with the endometrial cavity
primary infertility 4
Trophoblast origin
Outer blastocyst
Differentiate into:
- cytotrophoblast
- syncytiotrophoblast
- intermediate trophoblasts
The function of syncytiotrophoblast:
Producing B-hcg
And may participate in human placental lactogen
Extra-villus pathway that differentiate to placental bed and intermediate trophoblasts that would participate in
- establishing materno fetal circulation
- infiltration of decidua myometrium and spiral arteries
intermediate trophoblasts secretes:
Human beta lactogen
High in PSTT
Prostaglandins interact with —— receptors
a family of eight different G-protein- coupled
The endometrial lying the myometrium in pregnancy termed
Decidua
Chorion function
Immunological acceptance
- secrete uterotonins inactivation enzymes like, prostaglandin dehydrogenase, oxytocinase, enkephalinase
The isthmus or uterus is the part btw
The anatomical internal os and histological internal os
the vessels supplying the skin and subcutaneous layers of ant abdominal wall and mons pubis.
Hint:(That the last letters is the first of the next one)
Superficial epigasrti(c) a., superficial (c)ircumfel(ex) a., superficial (ex)ternal pudendal a.
All of them arise from femoral a. Just below the inguinal lig. Within the femoral triangle.
The ovary lies in the shallow ovarian fossa its boundaries
The upper margin of this fossa is formed by the external iliac vessels, whilst the posterior margin is formed by the ureter and internal iliac vessels. Fascia over the obturator internus muscle forms the floor of this fossa.
uterine artery course
is a branch of the internal iliac artery, runs in the base of the broad ligament, and about 2 cm lateral to the cervix it passes anterior and superior to the ureter, reaching the uterus at the level of the internal os. The artery then ascends in a tortuous manner, running up the lateral side of the body of the uterus before turning laterally and inferiorly to the uterine tube, where it terminates by anastomosing with the terminal branches of the ovarian artery.
Lymphatic drainage of uterus
• The fundus drains along the ovarian vessels to the para-aortic nodes, although some drain with lymphatics which pass via the round ligament to the inguinal nodes. Metastases from the fundus of the uterus may, therefore, occur in the inguinal nodes.
• The body drains via lymphatics in the broad ligament to the iliac lymph nodes.
• The cervix drains laterally via the broad ligament to the external iliac nodes, posteriorly in the uterosacral fold to the sacral lymph nodes, and posterolaterally along the uterine vessels to the internal iliac nodes.
The inferior epigastric artery course
The inferior epigastric artery arises from the external iliac artery near the midinguinal point. It continues in a cephalad course along the posterior lateral portion of the rectus muscle and has an anastomosis with the superior epigastric arteries.
COLLATERAL CIRCULATION AFTER INTERNAL ILIAC ARTERY LIGATION
Internal Iliac Systemic:
Iliolumbar
Lateral sacral
Middle hemorrhoidal
Lumbar
Middle sacral
Superior hemorrhoidal
Important anatomic relationships of the ureter include the following:
■ The ureter lies medial to the ovarian vessels at the bifurcation of the internal and external iliac arteries entering the pelvic brim.
■ Theuretercoursesundertheuterinearteryapproximately at 1.5 cm lateral to the cervix.
■ The ureter lies directly on the anterior vaginal wall very near the place where the vagina is detached from the cervix during the hysterectomy.
POUCH OF DOUGLAS boundaries
Anterior: uterus, supravaginal cervix and posterior vaginal fornix
Posterior: rectum
Lateral: uterosacral ligaments.
It is 5.5cm above anal orifice.
The ovary is composed histologically of three parts
The outer cortical region contains both the germinal epithelium and the follicles. The medullary region consists of connective tissue, myoid-like contractile cells, and interstitial cells. Last, the hilum contains blood vessels, lymphatics, and nerves that enter the ovary.
Superficialy , the inferior part of the abdominal wall is supplied medially by ——— artery and laterally by ——- artery.
Both are branches of the —- artery.
the inferior part of the abdominal wall is supplied medially by the superficial epigastric artery and laterally by the superficial circumflex artery.
Both are branches of the femoral artery.
Below the superficial level deeper in the abdomen layer, the ——- artery supplies the medial part of the lower abdomen, and the ——- artery supplies the lateral part.
Both of these arteries are branches of the ——- artery.
Below the superficial level deeper in the abdomen layer, the inferior epigastric artery supplies the medial part of the lower abdomen, and the deep circumflex iliac artery supplies the lateral part.
Both of these arteries are branches of the external iliac artery.
In repeat caesarean section, there are often adhesions in the plane between the anterior rectus sheath and the rectus muscle and these may require surgical division in order to free the rectus sheath sufficiently from the muscle to enable it to be lifted superiorly and thus create sufficient space for subsequent delivery of the fetal head. Awareness of the vessels in this plane and use of cautery or ligation, if the vessels are divided, is crucial to avoid the risk of rectus sheath haematoma later on.
The ureters lie close to lateral fornices of the vagina at the level of the uterine cervix and pass directly under the uterine arteries at this point.
It is important to be mindful of the altered anatomy of the lower segment of the uterus during advanced stages of labour, as this is often the time in which caesarean section may be performed. In advanced labour, the cervix may be fully or almost fully dilated and so the lower segment is drawn up cephalad. If one is not vigilant, incision of the uterine cavity is performed at a level that in advanced labour may in fact be cervix and not lower uterine segment.
In these circumstances, the incision should be placed a little higher than it would be at early labour, in order to avoid incision of the cervix.
The uterus has several significant anatomical relationships that are of importance to the surgeon:
● The anterior wall of the uterus lies directly posterior to the superior part of the bladder, with the vesico-uterine fold of peritoneum coursing over the bladder and onto the anterior body of the uterus. The supravaginal cervix is also directly posterior to the bladder. ● The pouch of Douglas lies posterior to the uterus. This cavity has been used as a point of access to the pelvic intraperitoneal cavity via the posterior vaginal fornix. ● A particularly important relation is that of the ureters to the supravaginal cervix. Lying 1.5 cm lateral to the supravaginal cervix and passing directly beneath the uterine arteries, the ureters can be injured when the uterine arteries are ligated during a hysterectomy. ● Lateral to the uterus is the peritoneal broad ligament. A double, peritoneal layer forms the broad ligaments, running from the sides of the uterus out to the lateral walls and floor of the pelvis. In the upper free border of each side of the broad ligament lie the fallopian tubes. The lateral border of the broad ligament is drawn superiorly over the ovarian vessels as the suspensory ligament of the ovary. ● The ovaries lie within a small mesentery called the mesovarium, which is suspended from the posterior part of the broad ligament. ● The round ligaments run in the anterior layer of the broad ligament. They pass form the lateral border of the uterus to the deep inguinal ring on each side
The retroperitoneal avascualr spaces of the pelvis are classified as follows:
1- Bilateral:
Pararectal space
Paravesical space
2- Unilateral/midline:
Prevesical space
Rectovaginal space
Retrorectal or presacral space
Boundaries of anterior and posterior portions of midpelvis
Anterior portion bounded:
Anterior: lower border of symphysis pubis
Lateral: ischiopubic rami
Posterior portion bounded:
- dorsal: sacrum
- Lateral: sacrospinous forming the lower limits of the sacrosciatic notch
Mid-pelvis measurement:
Transverse ?
Anteroposterior ?
Transverse (interischial spinous):10.5 cm
Anteroposterior (from the lower border of symphysis pubis to the junction of S4-5): 11.5 cm
the classifications of pelvic inlet shapes called:
Caldwell-Moloy classifications
the classifications of pelvic inlet shapes are called:
Caldwell-Moloy classifications
anthropoid pelvis percentage
20-25% (has the longest AP diameter and Narrow TD diameter)
what are the (contents) structures running in lesser omentum?
1) common bile duct. (rt)
2) portal vein. (post)
3) hepatic artery. (Lt)
note that orders written above are in lesser omentum would be different when it enters the liver:
D rt & lt hepatic duct > Common hepatic Duct> when it’s joins the cystic duct called CBD.
structures pass through the superficial inguinal ring:
- ilioinguinal n
- round ligament of the uterus
platyploid (plate-shaped) pelvis percentage:
5 % (very long TD diameter, short AP diameter)
the 1/2 cm btw anatomical & histological cervical os called:
isthmus > which forms the lower uterine segment later on in late pregnancy
Transverse diameter of pelvic outlet:
to assess T.D. (distance btw two ischial tuberosities, Normally: 11 cm):
1- subpubic angle (it should >90 degrees “obtuse angle”)
2- fist test (if +ve means intertuberous distance > or =11 cm)
3- Thom’s rule (If intertubercular diameter+post. sagittal diameter < 15 cm take the pt to C/S) < cannot be done clinically only done by pelvimetry!
Diagonal conjugate lenghth:
12 cm
what is the lateral umbilical ligament?
lateral umbilical fold overlies the inferior epigastric artery (a branch of the external iliac artery) and its accompanying veins.
other names of skene’s gland:
- paraurethral ducts
- female prostate
the percentage of Android (heart-shaped) pelvis:
20 % (interfere with internal rotation of the baby).
boundaries of femoral ring:
-ant: inguinal lig
- med: lacunar lig
-lat: femoral vein
-post.: pectineus m.
greater sac communicating with lesser sac through ……. & what its boundaries?
epiploic foramen (foramen of Winslow)
its boundaries:
ant: lesser omentum
post: IVC
inf : 1st part of deudenum
sup: caudate lobe of the liver
what are the parts that contribute to broad ligament?
- mesoovarian
- mesosalpinx
- mesometra
- mesoteres
- infundibulopelvic (IP) lig (AKA:suspensory lig)
retroperitoneal structures:
SAD PUCKER
Suprarenal glands
Aorta
Duodenum “except D1”
Pancreas “except the tail”
ureter
colon “except the transverse & sigmoid”
kidney
esophagus
rectum
thickened lower part external oblique aponeurosis that attached to ASIS and pubic tubercle forming ……
inguinal ligament (pauport’s lig)
true conjugate length:
11 cm
other names of Bartholin gland:
- major vestibular gland
- valvovaginal ducts
Transverse diameter of pelvic inlet: …cm
13.5 cm
what is the medial umbilical ligament?
is the distal obliterated portion of the umbilical artery. It develops after birth when the umbilical cord is cut; the portion of the vessel gets replaced by fibrous tissue due to the lack of blood flow in the distal part of the umbilical artery. (hypogastric arteries)
while the initial part becomes the adult superior vesical artery.
- the most common sites of urteric injury:
1st- during clamping of uterine a.
2nd- at the distal part near the vault.
3rd- during clamping infundibulopelvic lig.
* the crossing of the ureter and uterine a. lateral to the uterus 1-1.5 cm (water-ureter- under the bridge)
…….. fascia in the perineum is the continuation of ……. facia of the abdomen, and the same fascia extends down laterally towards the thigh to be called fascia ……
colles , Scarpa , lata
true obstetrical conjugate length:
10.5 cm
what angular ectopic pregnancy?
one that is located in one of the lateral angles of the uterine cavity. The differential diagnosis and treatment of these conditions are important. saline infusion sonohysterography (SIS) to help in differential diagnosis btw it & interstitial pregnancy, accounts of 3 % where the ovarian and uterine a. crossed and it can be led to massive bleeding.
(The term “angular pregnancy” is sometimes used interchangeably with “cornual pregnancy”. the latter is best reserved for pregnancy within a congenitally-anomalous uterus, such as one of the horns of a bicornuate, or the rudimentary corn of a unicornuate uterus)
Each hip bone is formed by fusion of 3 bones which are:
-ilium
- ischium
- pubis
Cardinal ligament origin
cardinal ligaments arise from the arcuate line on the pelvic side walls
The artery of the round ligament of the uterus, also known as
Sampson’s artery, is a branch of the inferior epigastric artery. It runs under, and supplies, the round ligament of the uterus. It constitutes an anastomosis of the uterine artery and ovarian artery.
Histologic Subtypes of Cervical Cancer:
- Squamous cell: Keratinizing- Non keratinizing- Papillary
- Adenocarcinoma: Mucinous, Endocervical, Intestinal Minimal deviation Villoglandular, Endometrioid, Serous, Clear cell, Mesonephric.
- Mixed cervical carcinoma: Adenosquamous , Glassy cell
- Neuroendocrine cervical tumor: Large cell neuroendocrine, Small cell neuroendocrine
- Others: Sarcoma, Lymphoma, Melanoma.
Squamous cell carcinomas represent –% of all cervical cancer, and adenocarcinomas account for –% of cervical cancers. The other cell types are rare.
Squamous cell carcinomas represent 70% of all cervical cancer, and adenocarcinomas account for 25% of cervical cancers. The other cell types are rare.
Women with — —- syndrome are at higher risk of developing adenoma malignum (or Minimal deviation adenoocarcinoma of the cervix) which is characterized by cytologically bland glands that are abnormal in size and shape.
Women with Peutz jeghers syndrome are at higher risk of developing adenoma malignum (or Minimal deviation adenoocarcinoma of the cervix) which is characterized by cytologically bland glands that are abnormal in size and shape.
Neuroendocrine tumors ofthe cervix include large cell and small cell tumors. These rare tumors are highly aggressive, and even early-stage cancers have a relatively low disease-free survival rate despite treatment with radical hysterectomy and adjuvant chemotherapy (Gardner, 2011; Viswanathan, 2004). Often, neuroendocrine markers, including
Neuroendocrine tumors ofthe cervix include large cell and small cell tumors. These rare tumors are highly aggressive, and even early-stage cancers have a relatively low disease-free survival rate despite treatment with radical hysterectomy and adjuvant chemotherapy (Gardner, 2011; Viswanathan, 2004). Often, neuroendocrine markers, including chromogranin, synaptophysin, and CD56, are used to confirm the diagnosis. Uncommonly, endocrine and paraendocrine tumors are associated with these neuroendocrine tumors.
The external vulva includes
the mons pubis, labia majora and minora, clitoris, vestibule, vestibular bulbs, Bartholin glands, lesser vestibular glands, paraurethral glands, and the urethral and vaginal openings. Lateral margins of the vulva are the labiocrural folds.
superficial urogenital triangle compartments boundries and contents
The superficial space lies between Calles fascia (superficial perineal fascia) and the perineal membrane (deep perineal fascia), Within this space lie the ischiocavernosus, hulbospongiosus, and transverse perineal muscles and the highly vascular vestibular bulb and clitoral crus.
The lymphatics of the vulva and distal third of the vagina typically drain into
the superficial inguinal node group
The uppermost node is in the groin, under the inguinal ligament, and is called
Cloquet’s node (also Rosenmuller’s node)
The superficial inguinal nodes cluster within the femoral triangle that formed by ( boundries)
the inguinal ligament, sartorius muscle, and adductor longus muscle
The deep femoral nodes lie within
the borders of the fossa ovalis and just medial to the femoral vein. An inguinofomoral lymphadenectomy typically refers to removal of both superficial inguinal and deep femoral lymph nodes
Umbilical arteries is a continuouation of
Hypogastric artery
What is the last branch of aorta ?
Middle sacral artery
In what Gyn surgery do we worry about the middle sacral artery ?
Sacrocolpopexy
Sacral neurectomy
What is the origin of Inferior epigastric artery ?
External iliac artery
pararectal and paravesical spaces are divided by
the uterine artery
The pelvis outlet is also called
The inferior aperture ( the pelvic brim is the superior aperture)
Urethra length in Fe/male?
Female 4 cm
Male 22 cm
Parts of male urethra
3 or 4 parts ( some consider prostatic and pre-prostatic separate parts
Besides Membranous urethra and
Spongy urethra)
The median umbilical ligament is the embryological remnant of what fetal structure?
Urachus
The medial umbilical ligament is the embryological remnant of what fetal structure?
Represents the remnants of fetal umbilical arteries.
Sertoli cell function
Secrete inhibin
Forms blood-testis barrier
Has FSH receptor
Leydig cell function
Secretes testosterone
Has LH receptors
External Oblique Muscle origin
Origin: It arises from the external surface of the lower 8 ribs (ribs 5th–12th).
External Oblique Muscle Insertion
Insertion: The external oblique muscle courses diagonally anteriorly and inferiorly to get inserted upon the pubic tubercle, anterior half of iliac crests, and linea alba.
Internal Oblique Muscle origin
Origin: The internal oblique muscle arises from the thoracolumbar fascia, anterior two-thirds of the iliac crest, and the connective tissue deep to the lateral third of inguinal ligament.
Internal Oblique Muscle Insertion
Insertion: This muscle courses at a right angle to the fibres of the external oblique muscle and gets inserted on the inferior borders of 10th–12th ribs, linea alba and pecten pubis via the conjoint tendon. The aponeurosis of the internal oblique splits at the lateral edge of the rectus muscle into an anterior and posterior lamina to envelope the rectus abdominis muscle. The anterior layer blends with the aponeurosis of the external oblique. Posterior to the rectus muscle, this aponeurosis blends with the aponeurosis of the transversus abdominis to form a portion of the posterior rectus sheath. In most areas, the fibres of this muscle are perpendicular to the fibres of the external oblique, but in the lower abdomen, their fibres arch somewhat more caudally, and run in a direction similar to those of the external oblique.
Transversus Abdominis Muscle origin
This muscle arises from the internal surface of 7th–12th costal cartilages, thoracolumbar fascia, iliac crest, and connective tissue deep to the lateral third of the inguinal ligament.
Transversus Abdominis Muscle insertion
Coursing transversely to the midline, the upper three-fourths of the transversus aponeurosis lies behind the rectus muscle. The lower one-fourth of the aponeurosis passes in front of the rectus muscle. The fibres of transversus abdominis gets inserted into the linea alba along with the aponeurosis of internal oblique, and into the pubic crest and pecten pubis via the conjoint tendon.
Rectus Abdominis Muscle origin
This muscle takes its origin from the pubic symphysis and the pubic crest.
Rectus Abdominis Muscle Insertion
After taking their origin, the rectus muscle fibres run vertically to get inserted into the xiphoid process and the fifth, sixth, and seventh costal cartilages.
Pyramidalis muscle (absent in approximately 20%) origin
A small, vestigial, triangular-shaped muscle, the pyramidalis, arises from the pubic symphysis.
Pyramidalis muscle insertion
It inserts on the anterior surface of the pubis and the anterior pubic ligament. It ends in the linea alba which is especially thickened for a variable distance superior to the pubic symphysis. The pointed insertion of the pyramidalis muscles into the linea alba can be used for locating the midline.
The main blood vessels supplying the anterolateral abdominal wall are as follows:
■ Superior epigastric vessels and the branches of musculophrenic artery
■ Inferior epigastric and deep circumflex iliac arteries
■ Superficial circumflex iliac and superficial epigastric arteries
■ Posterior intercostal vessels of the 11th intercostal space and the anterior branches of the subcostal vessels.
The superficial blood vessels of anterior abdominal wall that originate from the femoral artery include
the superficial epigastric, the superficial circumflex, and the superficial external pudendal arteries.
The deep vessels of anterior abdominal wall that originate from the external iliac and the internal thoracic artery These include:
the inferior epigastric artery, the deep circumflex artery and the superior epigastric artery, which is the terminal branch of the internal thoracic artery. The internal thoracic artery also gives rise to the musculophrenic artery, which anastomoses with the deep circumflex artery.
Musculophrenic Artery’s origin? What supply?
The musculophrenic artery originates from the internal thoracic vessels and descends along the costal margin. It supplies the superficial and deep abdominal walls of the epigastric and upper umbilical regions.
10th and 11th posterior intercostal arteries and subcostal arteries origin ? supply What?
originate from aorta. They continue beyond the ribs to descend in the anterior abdominal wall between internal oblique and transversus abdominis muscles. They supply superficial and deep abdominal wall of lateral lumbar or flank region.
Superficial Epigastric Artery supply What part if anterior abdominal wall
It supplies superficial abdominal wall of pubic and inferior umbilical regions.
Superficial Circumflex Iliac Artery supply What?
It supplies the superficial abdominal wall of the inguinal region and the adjacent anterior thigh region.
Lymphatic Drainage of the Anterior Abdominal Wall
Lymphatics in the region above the umbilicus drain into the axillary lymph nodes. Lymphatics in the region below the umbilicus drain into the superficial inguinal nodes.
(Superficial inguinal lymph nodes also receive lymph drainage from lower abdominal wall, buttocks, scrotum, penis, labium majus, and the lower parts of the vagina and anal canal) The efferent lymphatic vessels from the superficial inguinal group of lymph nodes primarily drain into the external iliac nodes and, ultimately, the lumbar (aortic) nodes, eventually reaching the cisterna chyli and the thoracic duct.
Nerve Supply of the Anterior Abdominal Wall
The major nerves supplying the anterior abdominal wall include the thoracoabdominal nerves, subcostal nerve, the ilioinguinal nerves, the iliohypogastric nerves and the lateral cutaneous branches of the thoracic spinal nerves.
The usual treatment for actinomycosis consists of
high and prolonged doses of penicillin G (20 million units per day) or amoxicillin for 4 to 6 weeks, followed by penicillin V (4 g per day) orally for 6 to 12 months. Clindamycin, tetracycline, and erythromycin are an alternative in cases of allergy to penicillin.
acidophilic cells of anterior pituitary
somatotropes (growth hormone ( GH ) producing cells) lactotropes (prolactin (PRL) producing cells)
The decidua is classified into three parts based on anatomical location
- decidua basalis: Decidua directly beneath blastocyst implantation is modified by trophoblast invasion.
- decidua capsularis overlies the enlarging blastocyst and initially separates the conceptus from the rest of the uterine cavity consists of stromal decidual cells covered by a single layer of flattened epithelial cells.
- The remainder of the uterus is lined by decidua parietalis By 14 to 16 weeks’ gestation, the expanding sac has enlarged to completely fill the uterine cavity. The resulting apposition of the decidua capsularis and parietalis creates the decidua vera,
The decidua parietalis and basalis are composed of three layers
surface or compact zone—zona compacta; a middle portion or spongy zone—zona spongiosa—with remnants of glands and numerous small blood vessels; and a basal zone—zona basalis.
The zona compacta and spongiosa together form the zona functionalis. The basal zone remains after delivery and gives rise to new
endometrium.
What are the nerve roots that supply the brachial plexus?
C5–8 and T1
Klumpke paralysis, in which the hand is flaccid. results from injury of:
C8-T1 roots that supply lower plexus
Total involvement of all brachial plexus nerve roots injury results in
Horner syndrome
what is the most common brachial plexus nerve roots injury in shoulder dystocia and what the percent of recovery ?
Lindqvist and associates (2012) reported complete recovery in 86 percent of children with C5–6 trauma, which was the most common injury
Pudendal nerve course
From the anterior (ventral) rami of S2,S3,S4, after Passing btw piriformis and coccygeus, it leaves the pelvis through the greater sciatic foramen, it then crosses the ischial spine with the internal pudendal artery and re-enters the pelvis through the lesser sciatic foramen. Passes medially to the internal pudendal artery.
Pelvic splanchnic nerves provide parasympathetic innervation to the pelvis and are derived from ? Its function and supply What?
the ventral primary rami of S2–S4. They control micturition, defaecation and erection. The inferior hypogastric plexus is formed from fibres of the sacral splanchnic nerves, pelvic splanchnic nerves and hypogastric nerves, and supplies the viscera of the pelvis. The rectal plexus is a posterior division of the inferior hypogastric plexus
The internal pudendal vein drains into…., while the external pudendal vein drains into ….
The internal pudendal vein drains into the internal iliac vein and the external pudendal vein drains into the great saphenous vein.
The uterine plexuses lie in …, and drain into ….
the superior angles of the uterus, between the two layers of the broad ligament. They connect the ovarian and vaginal plexuses and drain directly into the hypogastric vein.
The sciatic nerve is a nerve of the posterior leg, derived from
L4–S3 and contains fibres from anterior and posterior aspects of the lumbosacral plexus.
The tibial nerve is derived from the —– and is a branch of the —- nerve.
The tibial nerve is derived from the anterior division of L4–S3 and is a branch of the sciatic nerve.
The femoral nerve origin, course, supply?
arises from the dorsal division of the ventral rami of L2–L4. It passes beneath the inguinal ligament to enter the thigh, where it then divides into an anterior and posterior division. It provides innervation to the quadriceps muscle and sartorius, as well as anterior cutaneous branches.
The upper two-thirds of anal canal is lined with —- epithelium and is supplied by the —– artery
The upper two-thirds is lined with cuboidal epithelium and is supplied by the superior rectal artery.
The lower one-third of anal canal is lined with —– epithelium and is supplied by the — artery.
The lower one-third of anal canal is lined with non- keratinised stratified squamous epithelium and is supplied by the inferior rectal artery.
Hilton’s line is
a white line which indicates the junction of the keratinised from the non-keratinised epithelium.
The fibres of which pelvic muscles blend with the internal anal sphincter.
The fibres of pubococcygeus blend with the internal anal sphincter.
The detrusor muscle is innervated from the
S2–S4 nerve root, but the main contribution is from S3.
The testes are oval glands that have an average length of —— cm and a diameter of —– cm.
The testes are oval glands that have an average length of 4–5 cm and a diameter of 2–3 cm.
the blood and nerve supply to the vagina are:
• Artery: superior– uterine artery inferior – vaginal artery
• Vein: vaginal vein
• Lymph: superior– internal iliac nodes inferior – superficial inguinal nodes • Nerve: sympathetic– lumbar splanchnic plexus parasympathetic – pelvic splanchnic nerves
Thetestisissuppliedby3arteries:
1Testiculararteriesthatbranchdirectfromtheaorta 2Cremastericarterythatbranchesfrominferiorhypogastric 3ArterytoVasDeferens branchofinternaliliac
BoundariesoftheFemoralTriangle:
Superior:Inguinalligament
Medial:Medialborderoftheadductorlongus Lateral:Medialborderofthesartorius Floor:Pectineus,AdductorlongusandIliopsoasmuscles
Roof:FasciaLata
lymphaticdrainageofthevagina
Thelowervaginadrainstotheinguinalnodeswhereastheuppervaginadrainstotheinternalandexternaliliacs
LevatorAnimusclereceivesitsarterialsupplyfrom
theinferiorglutealartery
Theinguinalcanalisreinforcedposteriorlybywhichstructure
TheConjointtendonAKAInguinalfalxreinforcestheposteriorwalloftheinguinalcanal.TheinguinalandlacunarligamentsarepartofthefloorTheaponeurosisofexternalobliqueisthemajorcomponentoftheanteriorwallwithfibresofinternalobliquereinforcingthelateralpart
Thesuperficialperinealpouchisborderedsuperiorlybywhat
Theperinealmembraneisthesuperiorborderofthesuperficialperinealpouch.TheinferiorborderisthefasciaofperineumAKAGallaudetfasciaAKAdeepperinealfascia.
Thedistaltransversecolonissuppliedbywhichartery?
Inferiormesentericartery
Whichareaofthehypothalamusreleasesallofthefollowing?
- Thyrotropin‐releasinghormone- Corticotropin‐releasinghormone- Oxytocin- Vasopressin- Somatostatin
Paraventricularnucleus
The rectum receives arterial supply through three main arteries:
- Superior rectal artery – terminal continuation of the inferior mesenteric artery.
- Middle rectal artery – branch of the internal iliac artery.
- Inferior rectal artery – branch of the internal pudendal artery.
The paravesical space is divided into medial and lateral paravesical spaces by
the obliterated hypogastric artery or the lateral umbilical ligament.
The dissection of ——- space exposes the uterine artery originating from the internal iliac artery.
The dissection of Latzko’s space exposes the uterine artery originating from the internal iliac artery.
A74yearoldpatientisseeninclinic.Shehasbeenfoundtohaveanovarianepithelialcancerwithmalignantcellsonpleuraleffsuionaspirate.SheisdiagnosedwithstageIVovariancancer.Whatisthe5yearsurvivalforstage4ovariancancers?
17%
Thedetrusorisdividedinto–layersconsistingof
Thedetrusorisdividedinto3layersconsistingofinnerandouterlayersoflongitudinalsmoothmusclewithamiddlecircularsmoothmusclelayer
Thesertolicellbarrierisoftendescribedasdividingtheseminiferoustubuleinto
anadluminal(centralorluminalpartofthetube)andbasallayers.Thebasallayercontainsthespermatogoniaandbloodandlymph.Theadluminallayercontainsspermcellsinvariousstagesofdevelopment.ThepresenceoftheSCBallowsforcontroloftheluminalenvironment.
Inthemaleurethrawhichisthenarrowestpart
Membranousurethra
Thereare3partstothemaleurethra:
1.Prostatic
2.Membranous
3.Spongy(AKAPenileorCavernouspart)
Theroundligamentleavesthepelvisviawhat?
Deepinguinalring
Theinternalandexternalanalsphinctersbothreceiveinnervationfromwhichspinalsegment?
S4
Internalanalsphincter is InvoluntarySympatheticcontractionand ParasympatheticrelaxationInnervationviaPelvicsplanchnicnerves(S4)
Externalanalsphincteris Voluntary InnervationviainferiorrectalbranchofpudendalnerveandperinealbranchofS4
Theascendingcolondrainsintothesuperiormesentericvein(SMV).WhatveindoestheSMVdraininto?
Thesuperiormesentericveinjoinsthesplenicveintoformthehepaticportalvein.
The pudendal nerve is a major somatic nerve of the sacral plexus. What its supply ?
Sensory – Inferior rectal nerve – innervates the perianal skin and lower third of the anal canal. Perineal nerve – innervates the skin of the perineum, labia minora and majora or posterior scrotum. Dorsal nerve of the penis or clitoris – innervates the skin of the penis or clitoris. Thus, responsible for the afferent component of penile and clitoral erection.
Motor – innervates the external urethral sphincter and the external anal sphincterthe by inferior rectal nerve branch, the pudendal nerve provides the voluntary/somatic control of faecal and urinary continence.
(Tip: a way to remember the continence function of the pudendal nerve is; S2, S3, S4 keeps the poo off the floor!).
The perineal nerve innervates Bulbospongiosus, Ischiocavernosus, Levator ani muscles (including the iliococcygeus, pubococcygeus and puborectalis).
The levator ani muscles also recieve innervation directly from the anterior ramus of the S4 nerve root.
During pudendal nerve course it cross which ligament?
Sacrospinous lig
Persistent occipito-posterior position found in which kind of pelvic
Android
Contents of inguinal canal:
in males consist of the spermatic cord (with the genital branch of the genitofemoral nerve) and the ilioinguinal nerve. For females, the contents include the round ligament, genital branch of the genitofemoral nerve, and the ilioinguinal nerve.
the progression from spermatogonial stem cell to mature sperm takes
Spermatogenesis takes 65–75 days
Bifurcation of aorta at which spine level
L4
The iliohypogastric nerve arises from
the anterior ramus of the L1 spinal nerve root of lumbar plexus
The following structures pass through the lesser sciatic foramen:
• Internal pudendal artery and vein
• Pudendal nerve (note the pudendal nerve first leaves the pelvis via the greater sciatic foramen, and then re-enters via the lesser sciatic foramen)
• Obturator internus tendon ( the only one among these exit from lesser only and it didn’t pass the greater foramen)
• Nerve to obturator internus
Ductus venosus connects :
Umbilical vein and inferior vena cava
perineal body lies just deep to the skin. It acts as a point of attachment for muscle fibres from the pelvic floor and the perineum itself:
Levator ani (part of the pelvic floor).
Bulbospongiosus muscle.
Superficial and deep transverse perineal muscles.
External anal sphincter muscle.
External urethral sphincter muscle fibres.
The deep perineal pouch (also deep perineal space) is the anatomic space enclosed in part by the perineum, and located superior to the perineal membrane. It is bordered inferiorly by the perineal membrane, also known as the inferior fascia of the urogenital diaphragm.
The deep perineal pouch contains:
Muscles:
- Deep transverse perineal muscles
- External sphincter muscle of male urethra
- External sphincter muscle of female urethra
- Compressor urethrae muscle in the female is sometimes include
- Urethrovaginal sphincter in the female is sometimes included
Other:
- Membranous urethra in the male; proximal portion of urethra in the female
- Bulbourethral gland (male).
- The Bartholin gland, the female counterpart is in the superficial perineal pouch
- Vagina (female)
Summary of lumbosacral plexus
In most patients, the aorta bifurcates at the union of – - – vertebrae
In most patients, the aorta bifurcates at the union of L4-L5 vertebrae
The hip flexors consist of 5 key muscles that contribute to hip flexion:
iliacus, psoas, pectineus, rectus femoris, and sartorius.
——– called the fatty Layer of the subcutaneous tissue
formerly Camper fascia
more fibrous layer is found closer to the rectus fascia and is named the the membranous layer of the subcutaneous tissue or ——
(formerly Scarpa fascia)
The base of the bladder rests on the anterior vagina, supported by the vaginal attachments to the —– fascia pelvis from the ischial spine to the pubic ramus.
The base of the bladder rests on the anterior vagina, supported by the vaginal attachments to the arcus tendineus fascia pelvis from the ischial spine to the pubic ramus.
The female urethra traverses the underside of the symphysis pubis, anchored by elements of the endopelvic fascia (sometimes designated as “urethropelvic ligaments”), and by periurethral elements of the levator ani and pelvic floor musculature. It is made up of a distinct epithelial lining wrapped in a pliable vascular coat (corpus spongiosum).
The urethral continence mechanism is thought to be localized to the proximal 2/3 and relies on both the periurethral support structures as well as the viscoelastic properties of the epithelium.
The bladder is also at risk for injury during hysterectomy, with
mobilization of the cervix and subsequent colpotomy. Similarly, vaginal cuff closure may compromise the posterior bladder base at the vesicovaginal fold.
The superficial inguinal nodes cluster within the femoral triangle formed by (its boundaries)
the inguinal ligament, sartorius muscle, and adductor longus muscle
