Lower Limb And Pelvis Flashcards
Arterial supply of uterus
Ovarian artery from L2- supplies ovaries
Uterine artery from internal iliac- supplies uterine tube
Vaginal artery from internal iliac- supplies middle uterine tube
Internal pudendal form internal iliac- supplies cervix
Ovaries
Broad ligament is anterior- posterior to ovaries Arterial supply form L2 aorta Ovarian vein into IVC on the right Ovarian vein into renal vein on left Nerve- aortic plexus Suspensory ligament- carries vessels Ligament of ovary
Position of uterus
Bladder empty- uterus antiflexion
Bladder fill- uterus anteversion
Uterus ligaments
2 forwards- pubocervical
2 backwards- sacralcervical
2 to both sides- transversecervical
Uterus arterial supply
Ovarian artery- suspensory ligament
Uterine artery- broad ligament
Suspensory ligament- ovarian artery, vein
Broad ligament- uterine artery form internal iliac
Uterus; broad ligament
Over Fallopian tube- mesosalpinx Over ovaries- mesovarium Over uterus- mesometrium Broad ligament drain to external iliac lymph Uterus- internal iliac
Rectum arterial supply
Superior rectal (inferior mesenteric)- portal vein Middle rectal (internal iliac)- internal iliac vein Inferior rectal (internal pudendal)- internal pudendal vein
Lymph: pararectal- inferior mesenteric- internal iliac
Nerve: inferior hypogastric plexus
Rectum
Transverse folds
Rectal ampulla (stool stored)
Anorectal junction
Bladder
2 superior vesicle artery
1 inferior vesicle artery/vaginal
Drainage of bladder and urethra- internal iliac lymph
Sphincters
Sphincter vesicae- internal, involuntary, neck of trigone
Sphincter urethrae- external, voluntary,
Clitoris
Crus- clitoris
Pudendal nerve and internal pudendal artery and vein
Pudendal n- dorsal nerve of the clitoris
Pudendal n- perineal n
Nerves of penis
Pudendal nerve- inferior rectal, superficial and deep perineal nerve
Perineal- scrotal branches
Dorsal of penis- deep perineal pouch
Male urethra
Pre-prostatic
Prostatic
Membranous
Penile (spongy)
Penis
Corpus cavernosum (extension of Crura) Corpus spongiosum (extension of bulb) Urethra through corpus spongiosum
Perineal body
Urogenital diaphragm attaches to this
Non-erectile Muscles
Ischiocavernosus- around the side
Bulbospogiousus- labia or bulb
Erectile tissue muscles
Ischiocavrnosus- crura
Bulbospongiosus- bulb of penis/ bulb of vestibule
Superficial perineal pouch
Males- ischiocavenosus, bulbospongiosus, superficial transverse perineal
Females- urethra, vagina, clitoris, penis
Urethra and vagina also in deep pouch
Deep perineal pouch
Urethra
Sphincter urethrae
Deep transverse perineal muscles
Internal pudendal vessels and branches
Female also: vagina, dorsal nerves of clitoris
Males also: membranous urethra, dorsal nerves of penis, bulbourethral glands, penile arteries
Urogenital triangle
Ischial tuberosities - pubic symphysis
Urogenital diaphragm- sphincter urethrae sandwiched between superficial and inferior fascia- membranous
Fuses together anteriorly but not to bone
Space for blood vessels
Superior Layer of fascia
Sphincter urethrae- deep perineal pouch
Inferior layer of fascia
Eternal anal sphincter
Attaches to Perineal body
Closes anus with puborectalis
Nerve- inferior recal of pudendal (S2-4)
Has 3 parts; deep, superficial, subcutaneous
Artery- superior rectal - inferior mesenteric
Lymph- above pectinate line- internal iliac
Below pectinate line- superficial inguinal
Anal canal
Internal anal sphincter- involuntary
External anal sphincter- voluntary
Anal columns- contains terminal branches of superior rectal
Rectum pierces pelvic floor- becomes anal canal
Ischioanal (rectal) fossa
Walls- is hail tuberosity and rectum
Roof- levator ani
Floor- skin
Contents- branches of pudendal nerve, internal pudendal artery and vein, adipose tissue
Anal triangle
Ischial tuberosity- coccyx= anal triangle
Ischial tuberosity- pubic symphysis= urogenital triangle
Prostate glands
Under bladder
Secretes enzymes and acid
Ejaculatory duct- meets urethra inside
Arterial- internal pudendal, middle rectal, inferior vesicle
Veins- deep dorsal of penis- plexus- internal iliac
Ligament and muscle hold it in place- levator ani, pubo-prostatic ligament
Lymph- testis- testicular, skin- superficial inguinal node
Seminal vesicles
Ejaculatory duct (vas deferens joins here) Arterial supply- inferior vesicle and prostate artery
Vas deferens
Through inguinal canal- over the bladder- seminal vesicles= ejaculatory duct- urethra
Posterior division of internal iliac
1st- iliolumbar
2nd- lateral sacral
3rd- superior gluteal
Anterior division of internal iliac
1st- umbillical- superior vesicle x2 2nd-obturator 3rd- inferior vesicle/uterine 4th- middle rectal 5th- inferior gluteal 6th- internal pudendal Inferior vesicle- prostatic Uterine- vaginal
Vessels
L4 aorta divides- common iliac
Common iliac- internal and external iliac
Pelvis- internal
Internal iliac divides- anterior and posterior divisions
Pudendal nerve
S2-4 Levator ani External anal and urethral sphincter Bulbospongiosus Ishiocavrnosus Transverse perineal Muscle Through greater and lesser sciatic notch
Levator ani
Nerve S4 and pudendal
Coocygeus
S4, 5
Sacral plexus
Superior gluteal L4, 5, S1 Inferior gluteal L5, S1, 2 Sciatic L4, 5, S1, 2 Pudendal S4-4 Nerve to obturator internus L5, S1 Nerve to piriformis S1-2
Levator ani
Pubococcygeus
Iliococcygeus- attaches to fascia of obturator internus
Pubococcygues-puborectile (sling), levator prostate, pubovaginalis
Innervation- pudendal and nerve to levator ani
Coccygeus
Ischial spine and sacrospinous ligament- attaches to
Flexes coccyx
Direct branch from sacral plexus S4-5
Pelvic diaphragm
Levator ani and coccygeus (pelvic floor)
Prevents prolapse
Levator ani is the roof of anal triangle
Psoas
Attach to T12-L4 of bodies and intervertebral discs
Flexes hip, bends trunk laterally, raises trunk from supinate position
L2-4 anterior rami
Iliacus
Iliacus and Psoas- iliospoas
Iliospsoas joins lesser trochanter of femur
Flexes hip
Femoral nerve
Ligament in pelvic wall
Sacrotaberous and sacrospinous ligament form greater and sciatic notch
Posterior sacroiliac ligament
Anterior sacroiliac ligament
Pubic symphysis= fibrocartilage
Contents of the femoral triangle
Lateral to medial NAVL
Femoral nerve, artery, vein
Deep fascia of the lower limb
Fascia latae thickens to form iliotibial tract
Cutaneous nerves- anterior
Anterior cutaneous branches of femoral L2-4
Superficial inguinal lymph nodes
Horizontal group- Medial: drain to anterior abdominal wall Lateral: drain to posterior abdominal wall Vertical group- Drain to superficial lower limb
Superficial vein
Great/long saphenous- medial, joins femoral vein
Short saphenous- plantar, posterior leg through roof of popliteal fossa, popliteal vein
Superficial epigastric- joins femoral, anterior thigh
Circumflex iliac- joins femoral
Accessory saphenous- joins femoral, going down
Femoral, obturator and sciatic nerves
Femoral L2,3,4- anterior thigh
Obturator L2,3,4- medial thigh
Sciatic L4,5,S1-3- posterior thigh
Pelvis- lower limb transition
Sciatic and gluteal nerve, artery, vein via great sciatic notch
Femoral nerve and vessels via sublingual space
Obturator nerve and vessels via obturator canal
