anatomy revision Flashcards
what are paracolic gutters??
spaces between the colon and the abdominal wall
pouches in women and men?? what is their clinical importance??
recto uterine - pouch of Douglas
vesico uterine
name 9 regions of the abdomen
r and l
epigastric, r and l flank, suprapubic, r and l iliac fossa
2 major arteries that supply blood to the brain??
coronary arteries
vertebral arteries
where do majority of the arteries of pelvis and perineum arise from??
internal iliac artery
where do the gonadal arteries arise from?
L2 - abdominal aorta
supplying the testicles and ovaries
where do superior rectal artery arise from??
inferior mesenteric artery
where does internal pudendal artery come from
internal iliac artery
where does anterior scrotal artery come from
external iliac artery, from the common iliac artery
clinical importance of anastomosis between uterine and ovary artery
ovarian artery coming from L2 (abdo aorta)
uterine artery coming from internal iliac artery
ovarian artery supplies part of uterus
clinical importance of anastomosis between uterine and vaginal artery
what structure Is v close to uterine artery and need to be careful when doing ligation??
ureter
need to be careful when doing hysterectomy
ureter wiggles when uterine artery does not
“water (ureter) under the bridge (uterine artery)”.
where do left and right side of gonadal vein drain to??
left -> renal vein
right -> IVC
where do the superior rectal vein mainly drain to??
internal iliac vein
some will drain into the hepatic portal system
or via lateral sacral veins into internal vertebral venous plexus
which plexus does obturator
nerve come from??
lumbar plexus
L2-L4
other ones from sacral plexus - eg. pudendal, sciatic nerve
S2,3,4??
PUDENDAL
pelvic splanchnic nerve - carries motor (also S2,3,4)
Nerve to levator ani
L4
lymphatics of pelvis - where do superior pelvic viscera go to??
There is a high amount of cross-over in the lymphatics of the pelvis - cancer can spread in any direction, pattern is not sufficiently predictable to anticipate spread
external iliac nodes -> common iliac, aortic
where do inferior or deep pelvic viscera go to first
deep perineum -> internal iliac nodes -> common iliac
where do superficial perineum go to first
superficial inguinal nodes
GONADS LYMPHATIC DRAINAGE
para-aortic
or lumbar
what makes up the ischium
ischial tuberosity - true hamstrings attach here, aka seat bone
pelvic inlet / brim structures
pelvic outlet structures
prominent part of sacrum
ilium
superior public ramus
pubic symphysis
pubic symphysis
ischiopubic ramus
ischial tuberosities
sacrotuberous ligaments
coccyx
why palpate pubic symphysis??
constant point to measure fundal height - and measure development of the foetus
pubic symphysis relaxes
are sacroiliac joints stable / unstable ??
what type of joint is it??
stable - synovial joint
importance of the 2 ligaments of pelvis??
what 2 foramina do they form
sacrotuberous
sacrospinous
protects against sudden weight transfer eg. jumping
greater + lesser sciatic foramina (when ligaments are not in place they are called greater + lesser sciatic notch)
clinical relevance - trauma
fractures tend to break in multiple places eg like a pretzel
clinical relevance - childbirth
- AP and transverse diameters of female pelvis are larger than male
- subpubic angle and pubic arch is wider
- pelvic cavity is more shallow in females
moulding
the movement of 1 bone over another, to allow the foetal head to pass thru the pelvis during labour
largest fontanelle??
soft spot
anterior
Above levator ani muscle = pelvis
below = perineum
ABOVE - parasympathetic, visceral afferents
BELOW - somatic sensory, pudendal nerve
suprapubic pain is from what levels
superior aspect of pelvic organs
T11-L2
inferior aspect of pelvic organs
S2,3,4
at what level is anaesthetic injected ??
L3-L4 region
epidural anaesthetic pathway
spinal anaesthetic pathway - what structures does it pass thru?
faster-acting anaesthetic compared to epidural
skin
supraspinous ligament
interspinous ligament
ligamentum flavum
what happens if there is a blockade of sympathetic tone to all arterioles in lower limb??
vasodilation
may also cause hypotension
what structure is used as a landmark for pudendal nerve block??
ischial spine
for things like forceps delivery, painful vaginal delivery, episiotomy incision (posterior fourchette, where the labia minora meet posteriorly, between vagina and perineum)
1-4th degree tear
1st - skin only
2nd -
3rd - anal sphincter
4th - thru anal sphincter and bowel
LSCS
what structures do you incise through??
Lower segment C-section, part of uterus where it is thinner,
incise thru
skin
fascia
anterior rectus sheath
rectus abdominis but NOT rectal muscles
fascia and peritoneum
retract bladder
uterine wall
amniotic sac
laparotomy vs laparoscopy - what structures do u cut thru
midline incision - which is bloodless but increases risk of wound complications
skin and fascia
linea alba
perineum
laparoscopy - sub umbilical incision
abdominal vs vaginal hysterectomy
removal of uterus either thru abdominal wall or vagina
nerve supply to abdo wall
7th-11th nerves turn from intercostal nerves to thoracoabdominal nerves
T12 = subcostal and iliohypogastric
L1 = ilioinguinal
blood supply to abdo wall
intercostal and subcostal arteries
superior epigastric artery
be careful of the inferior epigastric artery
relationship between arcuate line and rectus sheath
above = anterior and posterior rectus sheath
below = anterior rectus sheath
how to find the deep inguinal ring??
halfway between ASIS and pubic tubercle
structures found in pelvic inlet vs outlet
inlet = ilium, pubic symphysis
outlet =
Which nerves and vessels may be damaged as a result of pelvic trauma?
brachial nerve palsy - erb’s and klumpke’s
facial nerve damage
Describe the preferred position of the fetal head as it descends through each region of the pelvis during labour, through to delivery. Understand and describe why these rotations have to occur.
transverse
OA
3 muscles that make up the pelvic floor?
pelvic diaphragm
deep perineal pouch
perineal membrane
deepest layer of the pelvic floor??
what 2 muscle groups does it contain??
pelvic diaphragm
levator ani and coccygeus
3 muscle groups of levator ani
puborectalis
pubococcygeus
iliococcygeus
endo-pelvic fascia
pelvic ligaments - extra support
utero-sacral
transverse cervical
tendinous arch of pevlic fascia
tendinous arch of levator ani
what structures are inside the deep perineal pouch
to get rid of urine and fixate perineal body
dorsal vein of clitoris / penis
external urethral sphincter
compressor urethrae
-bulbourethral aka cowper’s gland in males
-deep transverse perineal muscle
what is the perineal membrane
covers the urogential triangle
superficial perineal pouch - contains erectile tissue
what makes up the clitoris and crura
corpus cavernosum
crura - like crucifix, long thing at each side
bulb
another name for greater vestibular glands
bartholin’s gland
in males, what makes up the bulb and crura
corpus spongiosum - bulb
corpus cavernous - crura
functions of pelvic floor
support to pelvic organs
normally tonically contracted
actively contracts during sneezing, coughing
helps maintain continence
-urinary (external anal sphincter)
-faecal (puborectalis contraction, smaller angle)
injury to the pelvic floor
*pregnancy
*childbirth
obestiy
chronic constipation
1st-4th degree of prolapse
1st - cervix has dropped down into the superior part of the vagina
2nd - more than halfway down
3rd - cervix is protruding from the vaginal orifice
4th - completely outside vagina
