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Repro and Sexual Health > Clinical Anatomy; pelvic mass, prolapse and incontinence > Flashcards

Clinical Anatomy; pelvic mass, prolapse and incontinence Flashcards

1
Q

What is the ovary suspended on?

A

Suspended on a mesovarium from the posterior aspect of the broad ligament

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2
Q

Where does the ovary lie in terms of the pelvic side wall?

A

Ovary lies in the ovarian fossa

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3
Q

What is the relationship of the ovary to the ureter and internal iliac vessels?

A

Anterior to these

Obturator nerve is lateral to the ovary

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4
Q

What is the arterial supply to the uterus?

A

Supplied by the uterine artery which are branches of the internal iliac artery

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5
Q

What arteries do the uterine arteries anastomose with?

A

Ovarian arteries

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6
Q

What is the venous drainage of the uterus?

A

Internal iliac veins

Ovarian veins

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7
Q

At what aspect will the uterine pass the uterus?

A

Laterally
Pass above the ureter
Lateral to cervix
Lateral to vaginal fornices

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8
Q

At what vertebral level does the ovarian artery leave the aorta?

A

L2

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9
Q

In what ligament will the ovarian arteries run?

A

Broad ligament

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10
Q

What is the name for the part of the broad ligament that acts as mesentery?

A

Mesosalpinx

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11
Q

What is the relationship of the ovaries to the peritoneum?

A

Truly intraperitoneal

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12
Q

How can ovarian cancer spread?

A

Lymphatic drainage

Direct peritoneal spread

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13
Q

What are common sites of ovarian cancer mets?

A

GI tract
Bladder
Liver
Spleen

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14
Q

Via what lymphatics will ovarian cancer spread?

A

Pelvic and para-aortic nodes

Will then spread to the supraclavicular (virchow’s) node

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15
Q

Where are the lymph nodes of the pelvis found?

A 
Run alongside: 
Obturator
Internal iliac 
External iliac
Common iliacs 
Pre-sacral nodes in tissue immediately anterior to sacrum
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16
Q

Where will pelvic lymph converge?

A

Para-aortic nodes

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17
Q

Where will the para-aortic nodes drain into?

A

Lumbar trunks

Coalesce to form the cisterna chyli (contains thoracic duct)

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18
Q

Where can the inguinal nodes be found?

A

Outside fascia lata
Shaped like a T below and parallel to inguinal ligament
Along termination of long saphenous vein
Deep group; medial to femoral vein and in femoral canal

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19
Q

Where will superficial elements of the perineum drain to?

A

Inguinal nodes

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20
Q

Lymph drainage of rectum?

A

Sacral and internal iliac

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21
Q

Lymph drainage of anal canal?

A

Internal iliac

Lower portion to superficial inguinal

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22
Q

Lymph drainage of bladder?

A

Internal and external iliacs

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23
Q

Lymph drainage of the prostate and proximal urethra?

A

Internal iliac

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24
Q

Lymph drainage of the distal urethra, penile urethra, penis and clitoris?

A

Superficial inguinal

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25
Q

Lymph drainage of the testis and ovaries?

A

Para-aortic

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26
Q

Lymph drainage of uterine tube, uterine fundus, upper uterine body?

A

Para-aortic

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27
Q

Lymph drainage of lower uterus, cervix and proximal vagina?

A

Internal and external iliacs

Sacral

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28
Q

Lymph drainage of distal vagina and vulva?

A

Superficial inguinal

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29
Q

What is the course of the ureter?

A

Lateral wall behind ovary
Inferior to the uterine artery
Posterior abdominal wall behind branches of superior mesenteric vessels (RHS) and inferior mesenteric vessels (LHS)
Enters bladder wall obliquely at posterolateral corners of trigone

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30
Q

What are the stages to micturition?

A

Destruror muscle supplied by parasymp derived from pelvic splanchnics S2,3,4
Urethral smooth muscle supplied by sympathetic derived from T10-L2 but descend to bladder and urethra via hypogastric nerve
Striated urethral sphincter and levator ani supplied by pudendal nerve

31
Q

How is continence maintained during bladder filling and storage?

A

Muscle tone in the striated urethral sphincter and in pelvic floor (pudendal)
Tone in urethral smooth muscle (symp)

32
Q

What is a normal voiding volume?

33
Q

Via what nerves is the sensation to micturate carried by?

A

Afferents that run in parallel with parasymp fibres

34
Q

Why is there pressure on the bladder during pregnancy?

A

The anteverted and anteflexed uterus that expands puts pressure on the bladder

35
Q

What is the vulva?

A 
Urogenital female triangle: 
Mons pubis
Labia majora and minora
Vestibule 
Vaginal orifice
Orifice of vestibular glands
Clitoris
36
Q

What is the anatomical location of the vagina?

A

Upward and backwards
Through the pubovaginalis
Anterior and posterior walls are opposed allowing a narrow opening
Wall is composed of smooth muscle and mucous membrane is folded

37
Q

Which vaginal fornix is directly related to the peritoneum of the recto-uterine pouch of douglas?

A

Posterior fornix

38
Q

Within the female urogenital triangle, what surrounds the urethra and vagina?

A

Striated, external urethral sphincter

Supplied via pudendal nerve

39
Q

What is the blood supply to the vagina and urethra?

A

Variable branches from uterine, vaginal and internal pudendal branches of internal iliac

40
Q

What is the venous drainage of the vagina and urethra?

A

Vaginal plexus draining to internal iliac veins

41
Q

What is the clitoris?

A

Commences at right and left crura (attached to ischopubic rami and covered by ischiocavernosus muscle)
Surrounded by deep fascia and supported by suspensory ligament
Glans is erectile tissue covered by highly sensitive thin skin

42
Q

Where can the vaginal vestibular be found?

A

Between labia minora

43
Q

What covers the bulbs of the vagina?

A

Bulbospongiosus muscle
Bulbs are attaches to the superficial surface of the perineal membrane
Meet at the anterior commissure at front of urethra

44
Q

What is found under the posterior end of each vaginal bulb?

A

Greater vestibular gland

45
Q

Describe the urethra in men?

A

Lubricated by mucous glands

Receives reproductive glands; prostatic and ejaculatory and spongy

46
Q

Through which structure does the membranous urethra pass?

A

Urogenital diaphragm

47
Q

Through which structure does the spongy urethra pass through?

A

Bulb of penis and then into corpus spongiosum

48
Q

What surrounds the bulb of the penis?

A

Bulbospongiosus muscle

49
Q

What is the arterial supply to the prostate, penis and urethra?

A

Inferior vesical
Artery to bulb
Dorsal artery of penis

50
Q

What is the venous drainage of the prostate, penis and urethra?

A

Prostatic plexus

Internal iliac vein

51
Q

What is the arterial supply to the female vulva and labia?

A

External pudendal arteries anteriorly (from femoral)

Posterior labial branches of internal pudendal posteriorly

52
Q

What nerves must an epidural anaesthetic cover to achieve anaesthesia?

53
Q

What are the supporting structures to the cervix and upper vagina?

A

Uterosacral, transverse cervical and pubocervical ligaments

54
Q

What are the supporting structures to the middle vagina?

A

Pelvic fasci; pubocervical fascia and rectovaginal fascia

55
Q

What are the supporting structures to the lower vagina?

A

Levator ani and perineal body

56
Q

Which ligaments attach to the uterus?

A 
Round ligament
Ovarian ligament
Uterosacral ligament
Transverse cervical ligament
Pubocervical ligament
57
Q

Describe the uterosacral ligament

A

Strong structure that passes upwards and backwards from the posterior cervix towards lateral sacrum

58
Q

Describe the transverse cervical ligament

A

Attaches to the cervix and upper vagina to the lateral walls of the pelvis

59
Q

What are the different parts of the levator ani muscle?

A

Pubococcygeus
Puborectalis
Iliococcygeus
Coccygeus

60
Q

Describe the difference in location of the vestibular gland in men and women?

A

Men; deep perineal area

Female; superficial perineal area

61
Q

What are factors that can lead to pelvic floor damage?

A

Increased intra-abdo pressure; obesity, chronic cough, occupational exercise, constipation, intra-abdo mass
Pelvic floor muscle trauma and denervation; obstetric trauma, pelvic fracture, congenital
Connective tissue; age, oestrogen deficiency, congenital or acquired, drug related (steroids)

62
Q

Proximal and distal attachement of coccygeus muscle

A

P; ischial spine

D; inferior end of sacrum and coccyx

63
Q

Proximal and distal attachment of puborectalis muscle

A

P; body of pubis

D; perineal body

64
Q

Proximal and distal attachment of pubococcygeus muscle

A

P; pubic bone, tendinous arch of obturator fascia

D; vagina, perineal body, rectum, coccyx

65
Q

Proximal and distal attachment of iliococcygeus muscle

A

P; ischial spine and tendinous arch

D; perineal body, coccyx

66
Q

Which muscle of the levator ani creates a sling around the rectum?

A

Puborectalis; forms the ano-rectal angle

67
Q

What is the main function of the pubococcygeus?

A

Compresses urethra, vagina and anus
Controls urine flow
Elevates recto-anal junction

68
Q

What vessels can be damaged when inserting a trochar through the obturator membrane or through sacrospinous ligament?

A

Obturator artery, vein and nerves
Insert trochar MEDIALLY
Sacrospinoud; pudendal nerve, artery and vein

69
Q

What muscle forms the lateral wall of the ischio-anal fossa?

A

Obturator internus muscle

70
Q

What forms the roof of the ischio-anal fossa?

A

Levator ani and anal canal

71
Q

What is the purpose of the ischio-anal fossa?

A

Allows rectal distention during defecation

Can be involved with abscesses

72
Q

What is the clinical relevance of the ischioanal fossa?

A

Pudendal nerve passes in the lateral wall

Therefore for pudendal block and episiotomy, needle inserted through

73
Q

What is the classical presentation of someone with an infection in the ischioanal fossa?

A

U shape redness around back of rectum

74
Q

Where anatomically is the urogenital triangle?

A

Subpubic angle between ischiopubic rami

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