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Year 1 Anatomy > GI Anatomy 7 > Flashcards

GI Anatomy 7 Flashcards

1
Q

What vertebral level does the aorta birfurcate?

A

L4

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2
Q

What vertebral level does the common iliac divide into an internal and external branch?

A

Between L5 and S1

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3
Q

When does the external iliac become the femoral?

A

When it passes deep to the inguinal ligament

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4
Q

What branch does the external iliac give off before it passes deep to the inguinal ligament?

A

Inferior epigastric

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5
Q

What is the course of the inferior epigastric?

A

Ascends on the anterior abdominal wall and anastamoses with the superior epigastric (continuation of internal thoracic artery)

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6
Q

Other than the internal iliac artery what 2 other arteries supply structures in the pelvis?

A

1) Median sacral artery - comes off the bifurcation of the aorta and descends in the midline, crosses the pelvic inlet and gives rise to the last pair of lumbar arteries
2) Ovarian artery (in women) - come of AA, supply ovaries and anastamose with the terminal parts of the uterine arteries

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7
Q

What does the internal artery commonly divide into?

A

Anterior trunk which supplies pelvic viscera, gluteal region and thigh
Posterior trunk which supplies the body wall and gluteal region

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8
Q

What branches tend to come off the anterior branch of the internal iliac?

A

1) Umbilical artery
2) Superior vesical arteries
3) Inferior vesical/vaginal artery
4) Uterine artery (only in females)
5) Obtruator artery
6) Internal pudendal
7) Middle rectal
8) Inferior gluteal

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9
Q

Which arteries pass out of the greater sciatic foramen?

A 
Superior gluteal (above piriformis)
Inferior gluteal and internal pudendal (below piriformis)
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10
Q

Which artery passes out of the obtruator canal?

A

Obtruator artery

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11
Q

What artery leaves the pelvis by neither the greater sciatic or obtruator foramen?

A

iliolumbar artery from posterior trunk to supply muscles of the posterior abdominal wall

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12
Q

Why is the internal pudendal artery not just called the pudendal artery?

A

Because there is also an external, deep and superficial pudendal arteries

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13
Q

Which branches of the internal pudendal artery supply the erectile tissues of the penis and clitoris and vestibule in females?

A

Dorsal artery of the clitoris/penis

Deep artery of the clitoris/penis

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14
Q

What is the venous drainage of the majority of the pelvic viscera, what is the exception to this?

A

Pelvic viscera surrounded by a network of veins from which blood passes via vessels which mirror the arteries to reach the internal iliac veins

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15
Q

Into which vessels do the gonads drain?

A

right gonadal vein - into IVC

Left gonadal vein - into left renal vein

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16
Q

Most of the pelvic viscera drains into internal iliac nodes, where do these drain?

A 
Internal iliac
Nodes associated with common iliacs
Lateral aortic/lumbar nodes
Lumbar trunks
Cisterna Chyli
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17
Q

Into which nodes do the gonads drain?

A

Directly (via vessels that accompany the gonadal arteries) into lateral aortic/lumbar nodes and in some cases into pre aortic nodes

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18
Q

What nerve is in close relation to the ovary and what is the clinical significance of this?

A

Obtruator nerve - ovarian cancer = pain in medial thigh

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19
Q

What is the sacral plexus?

A

Somatic nerves

Formed by the ventral rami of S1-S4 and also receives contributions from L4 and L5

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20
Q

What are the 3 main sets of nerves/nerves present in the pelvis?

A

Sacral plexus - somatic
Autonomic plexus (pelvic plexus/inferior hypogastric)
Obtruator nerve

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21
Q

What are the 2 main branches of the sacral plexus, what do they supply and how do they leave the pelvis?

A

1) Sciatic nerve - lower limb - leaves via greater sciatic foramen
2) Pudendal nerve - perineum - leaves greater sciatic foramen with the internal pudendal artery

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22
Q

What autonomic nerves does the sacral plexus give rise to?

A

Pelvis splanchnic nerves (S2,S3,S4)

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23
Q

What vertebral level does the obtruator nerve come from?

A

L2,L3,L4

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24
Q

Other than the sciatic nerve, pudendal nerve and pelvic splanchnic nerves what else does the sacral plexus give rise to?

A

Nerves to supply the muscles of the pelvic floor - coccygeas, levator an

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25
Q

What is the nervi erigentes?

A

Another name for the pelvic splanchnic nerves because they are responsible for genital erection

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26
Q

Where does the pelvic plexus/inferior hypogastric plexus lie?

A

In the fascia around the rectum

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27
Q

What role do the parasympathetic nerves of the pelvic plexus have in micturation?

A

Stimulate bladder contraction

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28
Q

Where do sympathetic fibres to the pelvic viscera come from?

A

Thoracic and lumbar splanchnic nerves which branch off the sympathetic chain and travel via midline plexuses to join the pelvic plexus

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29
Q

Where do the sympathetic chains unite?

A

Infront of the sacrum

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30
Q

From the substance of what muscle do the roots of the sacral plexus emerge?

A

Piriformis

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31
Q

What is the obtruator canal bordered by?

A

Obtruator membrane and obtruator internus and superior pubic ramus

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32
Q

What passes through the obtruator canal?

A

Obtruator nerve artery and vein

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33
Q

What forms the pelvic floor anteriorly and posteriorly?

A 
Anteriorly = levator ani (puborectalis, pubococcygeus, iliococcygeus)
Posteriorly = coccygeus
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34
Q

What is the perineal body and what is its function?

A

Connective tissue structure positioned in the midline on the posterior border of the perineal membrane to which is attaches
Muscles of the pelvic floor and perineum attach to it

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35
Q

What is the function of the puborectalis muscle?

A

Forms a sling around the diaphragm as it pierces the pelvic diaphragm pulling the anal canal at a 90 degree angle to the rectum to prevent faeces freely passing out - forms part of the mechanism which keeps the gut closed

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36
Q

What is an episiotomy, when and why is it carried out?

A

Surgical incision made in the perineum (between vagina and anus) to prevent tearing during the delivering of a baby

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37
Q

Which bones make up the bony pelvis?

A

1) Sacrum
2) Coccyx
3) Right and left pelvic bones (ischium, ilium and pubis)

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38
Q

What is the acetabulum?

A

Point where the ischium, ilium and pelvic bones meet

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39
Q

What is the pectineal line on the bony pelvis?

A

Sharp superior margin of the superior pubic ramus

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40
Q

What is the arcuate line on the bony pelvis?

A

Ridge separating the upper and lower parts of the ilium

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41
Q

Which bony features define the pelvic brim?

A

1) Sacral Promontary (anterior to sacrum)
2) Margin of Ala (lateral to promontary, anterior margin sacrum)
3) Arcuate line (ilium)
4) Pectinate line (sharp superior line of superior pubic ramus)
5) Pubic crest
The last 3 make up the linea terminalis

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42
Q

Where does the sacrospinous ligament run to and from?

A

From the sacrum to the ischial spine

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43
Q

Where does the sacrotuberous ligament run from and to?

A

From the sacrum to the ischial tuberosity

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44
Q

Which ligament contributes to the borders of the greater sciatic foramen?

A

Sacrospinous ligament

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45
Q

Which ligaments contribute to the borders of the lesser sciatic foramen?

A

Superiorly - sacrospinous ligament

Inferiorly - sacrotuberous ligament

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46
Q

What are the 4 differences between a male and female bony pelvis?

A

1) Female has larger angle of pelvic arch (80-85, in men 50-60)
2) Female has circular pelvic inlet, male has heart shaped pelvic inlet
3) Female has less prominent medially projecting ischial spines
4) Female has less prominent projecting promontory

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47
Q

What is the perineum?

A

Space inferior to the pelvic floor, bounded by superiorly by the pelvic outlet and inferiorly by the skin

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48
Q

What line separates the perineum into the urogenital triangle and the anal triangle?

A

Line between the 2 ischial tuberosities

49
Q

How does the anal triangle lie in anatomical position?

A

Slightly posterior

50
Q

How does the urogenital triangle lie in the anatomical position?

A

Horizontally

51
Q

What is the ischioanal fossa?

A

Wedge shaped spaces in the lateral parts of the anal triangle (part of the perineum)

52
Q

What forms the walls of the ischioanal fossa?

A

Medially = levator ani
Laterally = obtruator internus
Inferiorly = subcutaneous tissue and skin
These converge superiorly where the levator ani joins the obtruator fascia (tendinous arch)

53
Q

Where does the rectum become the anal canal?

A

At the anorectal junction where the rectal ampulla narrows just before penetrating the pelvic floor (anus is the bit after passing through perineum)

54
Q

What is the epithelial lining of the upper 2/3 and lower 1/3 anal canal?

A

Upper 2/3 = simple columnar non ciliated

lower 1/3 = non keratinised stratified squamous

55
Q

What is the arterial blood supply to the upper 2/3 and lower 1/3 of the anal canal?

A

Upper 2/3 = superior rectal (from inferior mesenteric) and middle rectal artery
Lower 1/3 = inferior rectal artery from internal pudendal

56
Q

What is the venous drainage of the upper 2/3 and lowe 1/3 anal canal?

A

Upper 2/3 = superior rectal vein - inferior mesenteric

Lowe 1/3 = inferior rectal vein

57
Q

What is the nerve supply to the upper 2/3 and lower 1//3 of the anal canal?

A

Upper 2/3 = Inferior hypogastric plexus

Lower 1/3 = inferior rectal nerves

58
Q

What are the anal columns?

A

The longitudinal folds into which the mucosa of the upper anal canal is arranged

59
Q

What are the anal valves?

A

Ridges at the inferior ends of the anal columns

60
Q

What forms the pectinate line and what does this mark?

A

Pectinate line = formed by anal valves

Marks the approximate margin between the embryologically different regions of the anal canal

61
Q

What 2 sphincters surround the anal canal?

A

The internal and external anal sphincters

62
Q

What does the internal anal sphincter lie around and what is it formed from?

A

Lies around the upper 2/3 of the anal canal

Formed from the thickened lower end of the circular smooth muscle of the rectum

63
Q

What are the 3 parts of the external anal sphincter and what is it formed from?

A

Striated smooth muscle surrounding the lower 2/3 of the anal canal
Has a deep, subcutaneous and superficial part

64
Q

What is the deep part of the external anal sphincter related to posteriorly?

A

The fibres of the puborectalis muscle

65
Q

What is the ischioanal fossa normally filled with?

A

Fat

66
Q

What is the nerve supply to the internal anal sphincter?

A

PS fibres from pelvic splanchnic nerves (S2-S4)

67
Q

What is the nerve supply to the external anal sphincter?

A

Inferior rectal nerve from pudendal (and a perineal branch of the 4th sacral nerve)

68
Q

What happens to the ischioanal fossae anteriorly and posteriorly?

A

Anteriorly they extend into the urogenital triangle

Posteriorly they unite

69
Q

What are haemorrhoids?

A

Engorgement of the venous plexus at or inside the anal sphincter
Symptoms = pain, irritation, swelling
Internal - have a tendency to bleed
External
Prolapsed - internal haemorrhoids which have passed outside the anal canal and form lumps

70
Q

Where does the superficial perineal (Colle’s) fascia lie?

A

Deep to the perineal skin
Extends from one inferior pubic ramus to the other anteriorly and forms the inferior boundary of the superficial perineal pouch

71
Q

What is located in the superficial perineal pouch?

A

The attachments of the external genitalia (in the male also the testes and vas)

72
Q

What is a fistula and why do they form in the ischioanal fossae?

A

Fistula = abnormal or surgically made passage between a hollow or tubular organs and the body surface or between 2 organs
Ischioanal fossae are common sights of infection which results in abcesses which may rupture to produce a fistula

73
Q

what is the pudendal canal?

A

Fascial canal in the lateral wall of the ischioanal fossae in which the pudendal nerve and internal pudendal artery and vein travel

74
Q

How does the pudendal nerve enter the anal triangle and thus ischioanal fossae?

A

Passes through the lesser sciatic foramen

75
Q

What branches does the pudendal nerve give off as it travels through the pudendal canal?

A

Inferior rectal nerve
Perineal nerve
Continues as the dorsal nerve of penis/clitoris

76
Q

How and why would you carry out a pudendal nerve block?

A

During second stage of labour or minor vaginal surgery
Injection of local anaesthetic into pudendal nerve proximal to its terminal branches
2 approaches are transvaginal and transcutaneous (or perineal)

77
Q

What is the urogenital diaphragm, where does it extend between and what does it merge with posteriorly?

A

A triangular layer of muscle and dense fascia which extends between the inferior ischiopubic rami and merges with the perineal body posteriorly

78
Q

What is the fascial component of the urogenital triangle termed?

A

The perineal membrane

79
Q

What does the urogenital diaphragm do?

A

Seperates the urogenital triangle into a deep and superficial part

80
Q

What structures pierce the urogenital diaphragm?

A

Urethra in both sexes

Vagina in the female

81
Q

What forms the external urethral sphincter?

A

Muscles within the urogenital diaphragm (external urethral sphincter is considered to be within the deep perineal pouch)

82
Q

What is the nerve supply to the external urethral sphincter?

A

Branch to the deep perineal pouch from the perineal nerve (From the pudendal nerve)

83
Q

Which vessel does the external pudendal artery branch off and what does it supply?

A

Branches off the femoral artery in the thigh

Supplies the anterior scrotumj

84
Q

What are the branches of the internal pudendal artery?

A

1) Inferior rectal artery
2) Perineal artery which gives rise to a vessel to the musculature of the superficial perineal pouch and continues as the posterior scrotal or labial artery
3) Artery to bulb which gives rise to an artery to the external urethral sphincter and other muscles of the deep perineal pouch)
4) Deep artery of penis or clitoris
5) Dorsal artery of penis or clitoris

85
Q

Why would rupture of the urethra in the bulb of the penis lead to swelling of the scrotum penis and lower abdominal wall?

A

Urine escapes into superficial perineal pouch leading to swelling of the penis and scrotum
Urine escapes into the deep perineal pouch and travels up around prostate and bladder leading to swelling of lower abdominal wall

86
Q

What is the bulb of the penis and the crura of the corpus cavernosa?

A

Bulb of the penis = attached part of corpus spongiosum

Crura of the corpus cavernosa = attached part of corpus cavernosum

87
Q

What is the attachments of the bulb of the penis?

A

Attached to the perineal membrane

88
Q

What is the attachments of the crura of the corpus cavernosa?

A

Runs on the medial surface of the ischiopubic rami and is attached to the perineal membrane (fascial layer of the perineal diaphragm)

89
Q

What is glans penis?

A

Expanded part of corpus spongiosum

90
Q

What are the 4 parts of the male urethra?

A

1) Prostatic urethra - through prostate gland
2) Membranous urethra - from prostatic urethra through urogenital diaphragm to the buld of penis
3) Bulbous urethra - running through the bulb of the penis
4) Spongy urethra - through corpus spongiosus

91
Q

What is the mucosal fold in the male urethra?

A

Fold at posterior part of penile urethra

92
Q

How should a urethral catheter be passed in a male?

A

Directed to the base of the urethra until its passed the mucosal fold and then should pass easily

93
Q

What are the actions of the bulbospongiosus and ischiocavernosus muscles?

A

Bulbospongiosus - move blood from the attached parts of the penis/clitoris into the glans (in men also removal or residual urine from urethra after urination and pulsatile emission of semen during ejaculation)
Ischiocavernosus - Move blood from the attached part of the penis into the erect penis or clitoris

94
Q

What is the innervation of bulbospongiosus and ischiocavernosus?

A

Pudendal nerve (S2-S4) (Specifically the branch called the perineal nerve - superficial branch?)

95
Q

What arteries supply the penis?

A

The deep artery of the penis
Dorsal artery of the penis
Both come off the internal pudendal artery

96
Q

Through what does the urethra run in the penis?

A

Corpus spongiosum

97
Q

What are the erectile tissues of the penis?

A

2 Corpus cavernosa lie dorsally in anatomical position

1 corpus spongiosum lies ventrally in anatomical position

98
Q

Through what do the deep arteries of the penis run?

A

Through the corpus cavernosa

99
Q

What is the mechanism of penile erection?

A

Vascular event generated by PS fibres
Stimulation of these nerves causes specific arteries in the erectile tissues to relax allowing blood to fill the tissues and the penis to become erect

100
Q

What is the sensory nerve supply to skin of the scrotum?

A

Anteriorly the ilioinguinal nerve

Posteriorly the posterior scrotal nerve which is the continuation of the perineal nerve, a branch of the pudendal nerve

101
Q

From what is the tunica vaginalis derived?

A

The peritoneum - remnant of the processus vaginalis - pouch of peritoneum dragged down when the testes descended

102
Q

What artery lies medial to the deep inguinal ring?

A

Inferior epigastric

103
Q

What is an indirect hernia?

A

Passes through deep inguinal ring

104
Q

What is the vulva?

A

Name for the female external genitalia

105
Q

What is the vestibule in the female vagina?

A

Area between the labia minora

106
Q

What is the mons pubis in the female vagina?

A

Rounded mass of fatty tissue over the pubic symphysis - forms the anterior part of vulva

107
Q

What is the perineal raphe?

A

Line between the vaginal opening and anal aperture in females

108
Q

Why are urinary tract infections more common in females than males?

A

Women have a shorter urethra - less distance for the bacteria to travel to the bladder

109
Q

What is the bulb of the vestibule in women and what is it attached to?

A

Mass of erectile tissue in which lies under the skin and fat of the labia majora - split into a left and right side with the vaginal opening running between the 2 sides
Firmly attached to the perineal membrane
Partially overly the greater vestibular glands and are themselves covered with a thin sheet of muscle called the bulbus spongiosus

110
Q

What forms glans clitoris?

A

The joining of the 2 bulbs of vestibule anterior to the external urethral opening

111
Q

`Other than the bulbs of vestibule what other masses of erectile tissue contribute to the formation of the clitoris and which part do they form?

A

Corpora cavernosa

Form the body of the clitoris

112
Q

What is the crus of the clitoris?

A

Attached part of the corpus cavernosa which is attached to the perineal membrane running along the medial surface of the ischiopubic rami

113
Q

What is the function of the Bartholin’s or vestibular glands?

A

Pea shaped mucous glands on each side of the vaginal openings (female version of the bulbourethral glands) - like the bulbourethral glands they produce secretions during sexual arousal

114
Q

To which nodes does lymph from the perineal structures drain?

A

Deep parts of perineum - internal iliac nodes
Superficial tissues of penis and vagina - superficial inguinal nodes
Clitoris and penis - deep inguinal nodes and external iliac nodes
Testes - aortic/lumber/pre aortic nodes between L1 and L2

115
Q

What is formed in infections of the vestibular glands in a female?

A

Bartholin’s cyst

116
Q

In the male what part of the urethra do the bulbourethral glands empty into?

A

The membranous urethra

117
Q

What nerve is responsible for the cremasteric reflex?

A

The genital branch of the genitofemoral nerve which innervates the cremasteric muscles within the coverings of the spermatic cord

118
Q

What is the blood supply to the anterior and posterior scrotum?

A

Anterior - external pudendal from the femoral artery

Posterior - posterior scrotal from the perineal artery from the internal pudendal

Year 1 Anatomy (13 decks)

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