Exam review Flashcards
Sciatic Nerve: Description
The sciatic nerve is the major posterior nerve of the leg and thigh. It is the largest nerve in the body
Sciatic Nerve: Gross anatomy
It is a branch of the sacral plexus arising from the L4-S3
- It passes through the greater sciatic foramen to the piriformis muscle and then continues between the gluteus medius and maximus in the inferomedial portion of the buttock.
- There are two key components which are present from its origin, which are the tibial nerve and the common peroneal nerve.
- It passes down the back of the thigh between the heads of biceps femoris and passes into the popliteal fossa
- It is the deepest structure within the popliteal fossa
- Within the popliteal fossa it divides into the tibial and common peroneal nerves
Sciatic nerve: Branches
- Articular and muscular branches before dividing into terminal branches
- Supply the hip joint
- Muscular branches
- Biceps femoris
- Semimembranosus
- Semitendinosus
- Adductor magnus
Sciatic nerve arterial supply
- Perforating branches of the profunda femoris
- Branches of the superior and inferior gluteal muscles
- Branches of the popliteal artery
Sciatic nerve: supplies
- Hamstrings (tibial division)
- Knee joint
- Posterior cutaneous branches of the thigh
Sciatic nerve: Relations
- Upper – posterior part of the ischium, nerve to quad femoris, obturator internus, gemelli
- Lower: adductor magnus
- Upper – posterior part of the ischium, nerve to quad femoris, obturator internus, gemelli
- Upper – gluteus maximus
- Lower – long head of biceps femoris
- Upper – gluteus maximus
- Accompanied by the posterior femoral cuteanous nerve and the inferior gluteal arrtery
Sciatic nerve variants
- Abnormal course
- Abnormal branching
- Contributions from other nerve roots
- High division prior to the popliteal fossa
- Low division below the popliteal fossa
Common hepatic artery
- Terminal branch of the coeliac artery
- Anterior to the pancreas
- Inferiorly in the lesser sac towards the first part of the duodenum
- Gives off the right gastric artery running superiorly along the right lesser curvature of the stomach
- Passes slightly upwards and runs anterior to the portal vein and medial to the CBD in the free edge of the lesser omentum
- Anterior to the pancreas
- Gives off the gastroduodenal artery
- Becomes the proper hepatic artery
Proper hepatic artery
- Anteromedial to the portal vein and medial to the CBD within the hepatoduodenal ligament
- Terminates by bifurcating into the right and left hepatic arteries before entering the porta hepatis
RIght hepatic artery
- Course:
- Passes upwards and to the right
- Behind the common hepatic duct to enter Calots triangle
- Gives off the cystic artery
- Turns upwards to enter the right lobe
- Anterior segmental branch (segments V, VIII and I)
- Posterior segmental branch (VI, VI)
- Anterior segmental branch (segments V, VIII and I)
Left hepatic artery
- Runs vertically towards the umbilical fissure and supplies segments I, II and III
- Gives off a middle hepatic artery running towards the right side of the umbilical fissure
- Runs vertically towards the umbilical fissure and supplies segments I, II and III
- Medial segmental branch
- Lateral segmental branch
- Medial segmental branch
Hepatic artery variants
- Common hepatic artery
- From aorta
- From SMA
- Trifurcation
- From coeliacomesenteric trunk
- RHA
- From coeliac artery
- From SMA
- Accessory right hepatic from SMA
- LHA
- From LVA
- Accessory left hepatic from LGA
- MHA
- From the LHA
- From RHA
- Trifurcation of PHA
- Can have an extrahepatic course and traverse Calot’s triangle
Lymph nodes of the neck: Level 1
- Submental and submandibular
- S: mylohyoid muscle and mandible
- I: inferior border of the hyoid
- A: platysma
- P: posterior border of the submandibular
Lymph nodes of the neck: Level 2
- S: base of skull at the jugular fossa
- I: inferior border of the hyoid
- A: posterior border of the submandibular gland
- P/L: posterior border of the SCM
- M: medial border of the ICA
- Level 3
Lymph nodes of the neck: Level 3
- S: inferior border of the cricoid cartilage
- I: level of the clavicle
- A: anterior border of the SCM
- PL: postborder of the SCM
- M: medial border of the CCA
Lymph nodes of the neck: Level 4
- S: inferior border of the cricoid
- I: level of the clavicle
- A: ant border of the SCM
- PL: oblique line drawn through PL edge of the SCM and the anterior scalene
- M: medial border of the CCA
Lymph nodes of the neck: Level 5
- S: skull base at convergence of SCM and trapezius
- I: clavicle
- AM: post border of SCM
- PL: ant border of trapezius
Lymph nodes of the neck: Level 6
- S: inferior border of hyoid
- I: manubrium
- A: platysma
- P: trachea, and prevertebral space
- L: medial borders of the CCA
Pericardium: gross anatomy
- Two sacs from the pericardium: outer sac fibrous pericardium, inner sac double layered serous pericardium.
- Fibrous pericardium
- Tough connective tissue continuous with and bound to the central tendon of the diaphragm, roots of the major vessels, pretracheal layer of the deep cervical fascia, sternum via the superior and inferior sternopericardial ligaments
- Serous pericardium
- Parietal serous pericardium
- Visceral serous pericardium
- Fibrous pericardium
Rotator cuff: description
- The rotator cuff is a group of four muscles which act to support the unstable shoulder muscles. Provides support to the shoulder capsule except inferiorly, where it is the weakest. These consist of the supraspinatus, infraspinatus, subscapularis and the teres minor muscles.
Supraspinatus
- O: supraspinous fossa
- I: superior facet of GT of the greater tubercle of the humerus
- Innervation: suprascapular nerve
- A: suprascapular artery
Infraspinatus
- O: infraspinous fossa of the scapula
- I: middle facet of the GT of the humerus
- N: suprascapular nerve
- A: suprascapular artery and circumflex scapular artery
Subscapularis
- Supply
- Arterial: subscapular artery
- Similarly named vein
- Innervation: subscapular nerve
- Lymphatics: axillary
- Action: internal rotation
- O: subscapular fossa
- I: lesser tubercle
Teres Minor
- O: middle half of the lateral border of the scapula
- I: inferior facet of the GT
- A: posterior circumflex humeral artery, circumflex scapular artery
- N: axillary nerve!!!!!
Rotator cuff relations
- A: Tendon of pectoralis major
- P: tendon of latissimus dorsi
- M: Pectoral muscles
- L: deltoid
- S: Deltoid
- I: unstable free edge
Rotator cuff variants
- Absence or hypoplasia of any of the muscles
Pituitary gland: Description
- The pituitary gland is a major extradural endo- and exo-crine gland located within the pituitary fossa within the calvarium
Pituitary gland: Anterior
- Pars distalis
- Largest part – anterior wall of the Rathke pouch
- Pars tuberalis
- Part of the adenohypophysis surrounding the anterior aspect of the infundibular stalk
- Pars intermedia
- Thin layer of cells between the pars distalis and the neurohypophysis
Pituitary gland: Posterior
- Also known as the neurohypophysis
- Considered to be an extension of the brain and from an embryologically different source
- Secretes hormone stimulating hormones (ACTH etc)
- Produces the pituitary bright spot on MRI
- Continuous with the infundibulum
- Continuous with the hypothalamus
Borders of the pituitary fossa
- A: Anterior clinoid process
- P: dorsum sellae, posterior intercavernous sinus
- M: infundibulum
- L: dura mater cavernous sinuses and their contents
- S: Optic chiasm, suprasellar cistern, pituitary aneurysm
- I: sphenoid sinus
Pituitary: Arterial supply
- Rich anastamotic supply from the hypophyseal plexus which has branches from the meningohypophyseal trunk, and the anterior and posterior hyphohyseal arterial. This also allows for diffusion of the hormones
- 6 arteries, 3 from above, 3 from below
- Circuminfundibular anastomosis
- Inferior hypophyseal arterial circle
- Branches
- Above
- Superior hypohyseal artery
- Infundibular artery
- Prechiasmal artery
- Below
- Inferior hypophyseal artery
- Capsular
- Artery of the inferior cavernous sinus
- Above
- Portal
- Blood from hypothalamus
Pituitary relations
- S: optic chiasm
- I: sphenoid sinus
- L: cavernous sinus
- A: frontal/sphenoid sinus
- P:4th ventricle
Pituitary variants
o Empty sella
o Hypoplasia
o Hyperplasia
o Duplication
Peritoneum: description
- Large, complex serious membrane, forming a closed sac within the abdominal cavity
Peritoneum Gross anatomy
- Can be divided into two main compartments, separated by the roots of the transverse mesocolon
- Supramesocolic space
- Inframesocolic space
- Can also be divided into greater and lesser sac
- Innervation:
- Parietal: spinal nerves
- Diaphragmatic: phrenic
- Visceral: no afferent
- Mesenteroc: Pacinian corpuscles
- Parietal: spinal nerves
Peritoneum: Retroperitoneal organs
- Adrenal glands
- Kidneys
- Pancreas
- Aorta/IVC
- Duodenal segments D1/4
- Ascending and descending colon.
Peritoneal reflections
- There are multiple peritoneal reflections which provide support for intraabdominal organs including
- In the female:
- The broad ligament - doubled layer of peritoneum which drapes over the uterus, and contains the ovaries and Fallopian tubes
- Mesentery – doubled layer of peritoneum which contain neurovasculature for the abdominal viscera
- The appendix may have its own mesentery
- This allows for identification of the rectosigmoid junction – the rectum loses the mesentery
- Gastroduodenal
- Ligament of trietz
- Supports the duodenal-jejunal flexure
- Hepatorenal
- Contains the portal triad (portal vein, hepatic artery and the common bile duct)
- Lienorenal
- Contains the splenic artery and vein
Triceps brachii: Description
- The triceps is the muscle of the posterior compartment of the arm bilaterally
- Allows for extension of the elbow
Triceps brachii: Gross anatomy
- Originates as three heads:
- Long head – infraglenoid tubercle of the scapula
- Medial – posterior humerus inf to the radial groove
- Posterior and lateral intermuscular septum
- Insertion: olecranon process of the ulna
- Neurovasculature
- Innervation: radial nerve
- Arterial supply: branches of the brachial artery
- Venous drainage: venae commitantes
Triceps: Relations
- A: Radial nerve, humerus
- P: muscular fascia, skin, fat
- S: shoulder joint
- I: elbow joint
- M: coracobrachialis
- L: deltoid
- Radial nerve and profunda brachii vessels run in the groove between origins of lateral and medial heads
Triceps: variants
- Hypoplasia
- Abnormal insertion
- Abnormal origin
- Duplication of the long head
- Patella cubiti
- Long head may be supplied by axillary nerve
Pancreas: gross anatomy
- The pancreas consists of four parts
- Head (
- Uncinate process -
- Neck: thinnest part, ant to SMA, SMV
- SMV joins splenic vein behind the pancreatic neck to form the portal vein
- Body:
- Ant surface: covered by peritoneum
- Splenic vein
- Tail
- Head (
Between layers of splenorenal ligament
Pancreas: Ducts
- Main pancreatic duct
- Portion, proximal to the dorsal ventral fusion point
- Drains at ampulla of vater
- Connects with accessory pancreatic duct
- Pancreatic duct of Wirsung
- Distal portion
- Segment of the ventral duct between the dorsal ventral fusion point and the major papilla
- Accessory pancreatic duct of Santorini
- Portion of the duct distal to the dorsal ventral fusion point
- Drains anterior and superior portion of head
Pancreas Neurovasculature
- Arterial supply
- Superior pancreaticoduodenal artery (Coeliac trunk)
- Inferior pancreaticoduodenal artery (SMA)
- These divide into anterior and posterior branches
- Branches of the splenic
- Venous drainage
- Veins of the same name as the arteries
- Superior pancreaticoduodenal – portal vein
- Inferior pancreaticoduodenal - SMV
- Drains into the portal circulation
- Innervation
- Sympathetics via the pre-aortic and coeliac plexi
- Parasympathetics
- Lymphatics
- Coeliac, splenic, superior mesenteric, hepatic group of lymph nodes
Pancreas: Relations
- P:
- L2 vertebral body
- Right kidney hilum, portal vein and IVU|C
- CBD
- Aorta
- Left kidney hilum, left suprarenal gland, right crus
- Splenic vein, IMV and confluence of splenic and SMV to form portal vein
- A:
- Lesser sac: separating from stomach
- Lesser omentum and liver
- Attachment of the transverse mesovolon
- D1
- Infracolic compartment
- S:
- Origin of coeliac trunk
- SHA
- Splenic artery
PancreasL Variants
- Ansa pancreatica
- Pancreatic division
- 3 types
- Annular
- BIfid
- Ectopic
- Pancreactic clefts
Wrist joint: Description
- Synovial condyloid articulation
Wrist joint: Gross anatomy
- Articular surfaces
- Distal radius
- Triangular articular disc
- Scaphoid
- Lunate
- Triquetrum
- Ligaments
- Palmar radiocarpal ligament
- Dorsal radiocarpal ligaments
- Ulnar and radial collateral
- Palmar and dorsal radioulnar ligaments
- Capsule
- Continuous with midcarpal joint
- Proximally extends as the palmar radial recess
- Movement
- Flexion and extension
Radial and ulnar deviation
Wrist joint: neurovasculature
- Arterial supply
- Ulnar and radial arteries
- Dorsal and palmar carpal arches
- Venous drainage
- Cephalic and basilic veins
- Innervation
- Median nerve
- Radial nerve
- Ulnar nerve
Wrist joint relations
Anterior: radial artery, ulnar artery, median nerve, ulnar nerve, numerous flexor tendons
Posterior: numerous extensor tendons
Prostate: gross anatomy
- It is a pyramidal structure with the apex pointing inferiorly, measuring approximately 10cc in volume
- There are three surfaces: anterior, inferolateral and posterior
- AnteriorL posterior limit of the retropubic space. Connected to the pubic bone by puboprostatic ligaments
- Inferolateral: rests on the levator ani fascia
- Posterior: triangular and flat surface. Anterior to the rectum and has a vertical median groove. Separated by Denonvillier’s fascia.
- Has a pseudocapsule formed by fibromuscular tissue surrounding 3 distinct layers of fascia. Anterior, lateral and posterior . Laterally it fuses with the levator fascia
- It can be divided into to peripheral and central zone, which is connected by the transitional zone
- Zonal anatomy
- Peripheral
- Accounts for approximately 70% of the total in a young adult, deficient anteriorly
- Central
- Contains ejaculatory ducts
- Posterior to the prostatic urethra, forms the base
- Transition
- Remaining 5%
- Anterolateral to the prostatic urethra
- Peripheral
Prostate: neurovasculature
- Arterial supply: prostatic arteries from the inferior vesical
- Venous drainage into the prostatic plexus, which communicates with the internal pudendal plexus which communicates potentially with Baton’s vertebral plexus
- Lymphatic drainage is into the iliac and pre-aortic lymph nodes
- Innervation: pelvic splanchnic nerves and the hypogastric plexus.
Prostate: Relations
- A: Pubic symphysis
- P: rectum, fascia
- S: bladder
- I: penis, pelvic diaphragm
- M: prostatic urethra
- L: ischiorectal fossa
Prostate: Variants
Additional lobes
Missing lobes
Cubital fossa: Description
- Inverted triangular space which forms the transition between the arm and the forearm.
- Located anterior to the elbow joint
Cubital fossa: Boundaries
- S: line joining the medial and lateral humeral epicondyles
- L: medial border of brachioradialis
- M: lateral border of pronator teres
- Apex: meeting of the medial and lateral boundaries
- Roof:
- Deep fascia of the forearm
- Medial cutaneous nerve of the forearm, lateral cutaneous nerve of the forearm
- Basilic vein, cephalic vein, median cubital
- Floor: brachialis, supinator
Cubital fossa: Contents
- Brachial artery
- Brachial vein
- Median nerve
- Biceps tendon
- Radial nerve
- Posterior interosseous branch of radial nerve
Vertebral artery: Description
- The vertebral arteries are major arteries of the posterior circulation of the brain.
Vertebral artery: Gross anatomy
- Origin
- 1st part of the subclavian vein
- Termination
- Within the calvarium as the basilar arteries
- Course
- Can be divided into segments
- V1: angles posteriorly between longus colli medially and scalenus anterior laterally through the colliscalene triangle behind the CCA to entre the transverse foramen at C6
- Ant: CCA, VV, thoracic duct, lymphatic duct
- Post: ventral rami of spinal nerves C7 and C8, TP C7, inferior cervical ganglion
- AM: inferior thyroid artery, middle cervical ganglion
- Ant: CCA, VV, thoracic duct, lymphatic duct
- V2: through the transverse foramina from C6-3. Accompanied by VV and sympathetic nerves. Turns superolateral through inverted L shaped transverse foramen of C2
- V3: emerges from TP of C2 sweeping laterally to pass through the transverse foramen of C1, passes around the posterior border of lateral mass of C1, below the inferior border of the posterior atlanto-occipital membrane. Pierces the dura and arachnoid.
- V4: anterior to the roots of the hypoglossal nerve and joints its contralateral counterpart at the lower border of the pons
- V1: angles posteriorly between longus colli medially and scalenus anterior laterally through the colliscalene triangle behind the CCA to entre the transverse foramen at C6
- Can be divided into segments
Vertebral arteries: branches
- V1: segmental cervical muscular and spinal
- V2: anterior meningeal artery, muscular and spinal
- V3: posterior meningeal
- V4: anterior and posterior spinal arteries, medullary perforators, PICA
Vertebral artery: relations
- Relations
- A: clivus
- P: cerebellum
- M: Transverse foramina
- L: Transverse foramina
- S: Basilar artery
- I: subclavian artery (1st part)
Vertebral arteries: variants
- Hypoplastic
- Aplastic
- Duplicated
- Fenestrated
- Termination as the PICA
Inguinal canal: Description
- Passage in the anterior abdominal wall that transmits structures from the pelvis to the perineum
Deep inguinal ring
- Deep inguinal ring
- Laterally by the angle between the transversus abdominis and inguinal ligament
- Medially: inferior epigastric vessels
Superficial inguinal ring
- Inverted V shaped, triangular opening in the medial end of the external oblique aponeurosis
- Lateral crus: pubic tubercle
- Medial crus: pubic crest near the symphysis
- Posterior crus: pass behind the cord to attach to the rectus sheath
Inguinal canal: boundaries
- Superior: internal oblique, transversus abdominis
- Ant: external oblique aponeurosis and internal oblique aponeurosis
- I: inguinal ligament and lacunar ligament
- P: transversalis fascia, conjoint tendon
Inguinal canal: contents
- Spermatic cord in the male
- Ductus deferens
- Artery to the ductus deferens
- Genital branch of the genitofemoral nerve
- Iliolumbar
- Iliohypogastric
- Round ligament in the female
- Ilioinguinal nerve
- Genital branch of the genitofemoral nerve
Anal canal: Description
- The anal canal is the final part of the alimentary tract and is located within the pelvis. It is a single, midline organ
Anal canal: Gross anatomy
- Structure
- The anus can be separated into by the dentate line into superior and inferior segments
- The superior segment is considered visceral and the inferior segment is considered somatic
- Continence is partially preserved by the puborectalis sling.
- Boundaries
- Superior: levator ani
- I: external anal sphincter
Anal canal: neurovasculature
- Above the dentate line:
- A: superior rectal,
- N: least splanchnic nerve
- V: vein
- L: rectal nodes
- Below the dentate line:
- A: inferior rectal ,
- N: inferior rectal branches of the pudendal nerve
- V: internal iliac
- L:
Anal canal: Relations
- S: small bowel
- I: external anal sphincter
- M: anal canal
- L: ischio anal fossa
- A: female: uterus, pouch of douglas. Male: bladder, rectovesical pouch
- P: sacrum, pre-sacral fat
Rectum: Gross anatomy
- At the level of the S3 vertebral body,the sigmoid colon loses it mesentery
- Taenia coli flatten and fuse
- The anal canal extends from the levator ani to the external anal sphincter
Rectum: neurovasculature
- A: superior, middle and inferior rectal arteries,
- N: least splanchnic nerves, sympathetic nodes
- V: internal iliac plexus, external iliac plexus
Fallopian tubes: Gross anatomy
- Approximately 10-12cm long and 1-4mm in diameter
- The fallopian tubes consist of 5 parts
- Fimbriae
- Infundibulum
- Ampulla
- Isthmus
- Interstital or intramural
- They are open to the peritoneum bilaterally and are not directly connected to the ovaries
- They are directly continuous with the cornu of the uterus bilaterally
- They are contained within the doubled layer of peritoneum called the broad ligament, and have a separate section within it called the mesosalpinx.
Fallopian tube: neurovasculature
- A: branches of the ovarian and uterine arteries (
- N: pelvic splanchnic nerves
- V: uterine plexus which then drains into the internal iliac veins
- L: iliac group of lymph nodes
Fallopian tubes: relation
- A: bladder
- P: rectum
- S: broad ligament
- I: pelvic soft tissue
- M: cornu of the uterus
- L: pelvic side wall, ovaries
Fallopian: variants
- Duplication
- Absence
- Hypoplastic unilateral
- Hypoplastic bilateral
- Abnormal entry into the uterine body or fundus
Uterus: Gross anatomy
- 7.5cm in length, 5cm wide at its upper part, 2.5cm in thickness
- Divisible into two parts, cervix and body
- The uterus is a muscular structure which has multiple layer including endometrium and myometrium
- It is shaped as an inverted pear, with the broad side usually facing superiorly
- There is are cornu bilaterally which communicate with the fallopian tubes
- The central cavity is triangular in shape
- It is continuous with the cervix inferiorly, through the cervical os and canal
- A: pubocervical
- L: transverse cervical ligaments
- P: uterosacral
- I: puborectalis and pubovaginalis
- A: pubocervical
Uterus: neurovasculature
- Arterial
- Uterine branches of the superior vesical branches
- Anastamoses with the ovarian arteries
- Venous
- Uterine venous plexus draining into the internal iliac veins
- Lymphatics: inguinal and iliac
- Innervation: hypogastric and ovarian plexi, ¾ sacral nerves
Uterus: relations
- A: bladder
- P: rectum
- S: broad ligament
- I: cervix, vagina
- M: uterine cavity, endometrium
- L: fallopian tube s
Uterus: variants
- Didelphys
- Bicornuate
- Unicornuate
- Anteverted/retroverted
- Anteflexed/retroflexed
Ovaries: Gross anatomy
- They are egg shaped structures located along the lateral pelvic wall bilaterally measuring approximately 2cc in volume
- Within the shallow fossa in the angle between the internal and external iliac vessels
- They are surrounded by a doubled layer of peritoneum known as the broad ligament, within a separate enclosure known as the mesovarium
- Suspended within the suspensory ligament of the ovary running from the side wall to the ovary
- They communicate with the peritoneum and have the fimbriae of the fallopian tubes medial to them
Ovaries: neurovasculature
- A: ovarian arteries from the aorta, immediately below the renal arteries
- V: right drains directly into the IVC, left drains into the left renal vein.
- L: iliac lymph nodes or para-aortic
Ovarian relations
- A: broad ligament, mesovarium, obliterated umbilical artery
- P: ureter, internal iliac vessels, suspensory ligament with ovarian vessels
- S: external iliac vessels
- I: levator ani
- M: ovarian ligament, rectouterine pouch, bowel
- L: obturator vessles and nerves, obturator internus and fascia, parietal peritoneum
Ovarian variants
- Suprapelvic position on psoas major
- Inguinal canal location
- Shape: spheroidal, flattene, cresenteric
- Supranumerary
- Absence or hypoplasia
- Ectopic adrenal or thyroid tissue
- Polycystic
Testis: gross anatomy
- They are oval, egg shaped structures which measure approximately cc in volume
- They are surrounded by a fascial layer known as the tunica albuginea,
- From the mediastimum testis, there are several radiating septa extending into the testis forming 250-400 lobules. Contains 2-3 seminiferous tubules. Drains into the epididymis
- Efferent ducts in the head of the epididymis unite to form the globus minor in the body and tail region which continues as the ductus deferens
They are connected to the medial spermatic cord bilaterally which allows for ejaculation of sperm.
Testis: neurovasculature
- Testicular arteries are from the
- Venous drainage into the pampiniform plexus which surrounds the testes, then into the right and left testicular veins. The right drains directly into the IVC, the left drains into the left renal vein
- Innervation is from the
- Lymphatics: into the para-aortic or inguinal
TEsticular relations
- Superolaterally: epididymis
- Otherwise surrounded by the pampiniform plexus and the layers of fascia forming the scrotum
Testicular variants
- Unilateral undescended
- Bilateral undescended
- Unilateral/bilateral agenesis
- Polyorchidism
- Bilobed testes
- Tersticular appendages
Epididymis: Gross anatomy
- Elongated structure, posterolateral to the testis, can be subdivided into 3 parts. Head, body and tail
- Total length is 6-7cm
- Head is the largest and most prominent part, at the superior pole of the testis, measures approximately 5-12 mm in length can have an appendix
- Tail is found at the inferior pole
Male urinary bladder: gross antomy
- The bladder is a rounded structure
- It has a smooth outer surface and a slightly trabeculated inner surface, caused by the undistended detrusor muscle
- At the posterior inferior surface there is the with the two urerteric and single urethral orifice.
Male urinary bladder: neurovasculature
- A: superior (internal iliac) and inferior (internal ) vesical arteries
- V: similarly named veins
- Lymphatics: iliac and inguinal lymph nodes
- N: pelvic splanchnic, hypogastric plexus, sacral branches
Male urinary bladder: relations
- A: pubic symphysis
- P: rectum
- S: peritoneum – small bowel
- I: levator ani
- M: N/A
- L: iliac vessels
Male urinary bladder: variants
- Hypospadias
- Agenesis
- Duplication
- Ectopic ureteric insertion
Ischiococcygeus
- Attaches to the inner tip of the coccyx
- Ischial spine and along the tendinous arch of the obturator fascia
- Fuses with the pubococcygeus
Puborectalis
- Causes the angle at the recto-anal angle, and assists in faecal continence
- Is sling shaped
Pubococcygeus
- From the inner surface of the pubis and the obturator fascia with fibres fusing medially at the perineal body and musculature of the prostate/vagina
Levator ani: neurovasculature
- A: Internal pudendal branches of the internal iliac
- V:Into the pudendal branches of the internal iliac
- N: via the pudendal nerves of the lumbar and sacral plexi
- L: inguinal and iliac lymph node chains
Levator ani: relations
- A: pubic symphysis
- P: coccyx
- S: bladder, rectum, small bowel
- I: anus, ischioanal fossa
- M: N/A
- L: side walls of the pelvis
Psoas muscle: description
- Large paired muscle of the posterior abdominal wall and pelvis.
- Function: assists flexion of the hip, lateral flexion of the trunk. Stabiliser and flexor of the hip
Psoas muscles: relations
- The lumbar plexus forms within the psoas muscle bilaterally
- A: genitofemoral
- L: iliohypogastric, ilioinguinal, lateral femoral cutaneous, femoral nerves
- M: obturator, lumbosacral trunk
Psoas muscle: Variants
- Hypoplasia – unilateral/bilateral.
- Division of the femoral nerve into multiple slips within the psoas prior to uniting as a common trunk
- Origin from the sacrum
- Separate tendinous insertion to the iliacus
- Agenesis
- Psoas minor muscle
Anterior division of the internal iliac artery: Gross antomy
- Origin
- At the level of the pelvic brim where the internal iliac artery divides into its anterior and posterior divisions
- Division at the superior brim of the greater sciatic foramen
- Course
- Courses down the lateral wall of the pelvis
- Down the ischial spine anterior to piriformis giving off visceral and parietal branches
Branches of anterior division of internal iliac artery
- Umbilical artery
- Superior vesical
- Obturator
- Vaginal
- Inferior vesical artery
- Uterine artery
- Middle rectal
- Internal pudendal
- Inferior gluteal
Posterior division of the internal iliac artery: branches
- Iliolumbar
- Lateral sacral
- Superior gluteal
Femoral artery: Branches
- Superficial epigastric artery
- Superficial circumflex iliac artery
- Superficial external pudendal artery
- Deep external pudendal artery
- Terminal
- Profunda femoris
- Superficial artery
Femoral artery: course
- Emerges from the inguinal ligament medial to the midpoint of the inguinal ligament and medial to the deep inguinal ring, halfway between the ASIS and symphysis pubis
- Femoral vein medially
- Runs down the anterior and medial thigh with first 4 cm enclosed within the femoral vein
- Terminates within the femoral triangle
Femoral artery: Relations
- A: skin, superficial fascia, superficial iliac circumflex vein, superficial layer of fascia lata, anterior femoral sheath
- P: posterior femoral sheath, pectineal fascia, psoas major tendon, hip joint capsule, adductor longus, femoral vein
- L: femoral nerve
- M: femoral vein
Femoral triangle: boundaries
- L: Medial border of sartorius
- M: medial border of adductor longus
- S: inguinal ligament
- F: iliopsoas, pectineus
- R: skin, subcut tissue, scarpas fascia, GSV, superficial lymph nodes
Femoral triangle: contents
- Femoral nerve
- Femoral sheath: femoral artery, femoral vein, femoral canal
Popliteal artery: gross anatomy
- O: at the adductor canal
- Course
- Deepest structure on the floor of the popliteal fossa, superficial muscle
- T: lower border of popliteus, divides into the anterior tibial and the tibioperoneal trunk
Popliteal arteries: branches
- Superior and inferior, medial and lateral genicular arteries
- Middle genicular
- Muscular
- Cutaneous
Popliteal artery: relations
- Starts medial to tibial nerve and ends lateral to it
- Deep: popliteal surface of femur, knee joint capsular, popliteus
- S: popliteal vein, tibial nerve
- L: biceps femoris, lateral condyle of the femur, plantaris and lateral head of gastrocs
- M: semimembranosus, medial condyle of femur, medial head of gastrocs
Common fibular N: Gross anatomy
- O: one of the two terminal branches of the sciatic nerve , posterior divisions of the anterior rami of L4-S2
- Course: Diverges from the sciatic by sloping lateral and downwards to lie laterally in the popliteal fossa
- Remains subfascial and winds around the fibular neck and enters lateral compartment of the leg
- Divides into terminal branches into peroneus longus
Common fibular N: branches
- Peroneal communicating nerve
- Lateral sural
- Superior and inferior genicular
- Recurrent genicular
- Muscular
- Terminal branches
- Superficial and deep peroneal
Common fibular nerve: relations
- Ant
- Plantaris
- Lateral head of gastrocs
- Knee joint capsule
- Fibular origin of soleus
- Post
- Peroneus longus
Common peroneal nerve variants
- Level of the division
- Sural communicating branch- absent 20%
Femoral nerve: Gross anatomy
- Origin: post division of L2-L4
- Course:
- From lateral border of psoas to descend between the iliacus and psoas muscles
- Motor branch to iliacus prior to passing under the inguinal ligament
- Femoral triangle
- Above iliacus, outside and lateral to the femoral sheath
- Branch to pectineus
- Lateral femoral circumflex artery separates nerve into superficial and deep divisions
- Terminal branch reaches apex of the femoral triangle to become the saphenous vein
Femoral nerve: Branches
- Superficial division
- Nerve to sartorius
- Medial cutaneous nerve of the thigh
- Intermediate cuteaneous nerve
- Sympathetic vasomotor supply to blood vessels
- Deep
- Rectus femoris, vastus lateralis, intermedius and articularis genu, medialis,
- Continues as the saphenous nerve (passing behind sartorius)
Femoral Nerve: Variants
- Splits into separate slips within the psoas
- Accessory femoral nerve
- Femoral branch of the lateral femoral cutaneous nerve
- Saphenous nerve
Gluteus maximus
- O: Gluteal surface of ilium, behind posterior gluteal line, lumbar fascia, sacrum, sacrotuberous ligament
- I: Gluteal tuberosity, ITB
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Gluteus medius
- O: gluteal surface of ilium, between the middle and posterior gluteal line
- I: GT
Gluteus minumus
- O: gluteal surface of the ilium between middle and inferior gluteal lines
- I: GT
Gluteal muscle: surfaces and relations
- M: natal cleft
- L: hip joint
- S: muscles of the posterior back
- I: hamstrings muscles
- A: ilium
- I: sciatic nerve
Gluteal muscles: neurovasculature
- Max: superior and inferior gluteal arteries, med and min: superior gluteal artery
- V: Similar to arterial supply
- N: Medial and lateral gluteal nerves via the sacral plexus
- L: into the inguinal lymphatic chain
Gluteal muscles: actions
- Extends flexed thigh at that hip
- Stabilises hip and knee via attachment to ITB
- Gluteus medius and minimus abduct the hip joint
- Medial rotation of the thigh.