pelvic anatomy Flashcards
what are the muscles that make up the pelvic floor or pelvic diaphragm called
Levator Ani and coccyges
what are the names of the muscles that make up Levator Ani
-puborectalis
-pubococcygeus
- iliococygeal
what is the nerve supply to the pelvic diaphragm
pudendal nerve (s2-s4), perineal nerve of S4 and obturator nerve (L2-L4)
piriformis is a muscle that makes up the pelvic floor
True or false
False
what is the primary function of piriformis muscle
external rotation of the hip
what is the nerve origin of pudendal nerve
S2-S4
what are the branches of the pudendal nerve
PID
- Perineal nerve
-inferior rectal nerve
-Dorsal nerve of the clitoris or penis(in men)
what type of epithelium lines the bladder
transitional epithelium
what is the name of the muscle found in the bladder and how many layers does it have
detrusor - 3 layers
what is the part of the bladder called that is referred to as a ‘triangle’ and encloses the ureter orrifeces and the urethra
trigone of the bladder
What is the embryological origin of the bladder (not the trigone of the bladder)
urogenital sinus - cranial portion
what is the average length of the uretha in
A - males
B - females
males - 22-29cm, average 25cm
Women- 2-4cm
What is the role of the parasympathetic NS to the bladder; what is the parasympathetic nerve that supplies the bladder
parasympathetic = peeing - detrusor contraction
pelvic splanchnic s2-s4
what is the role of the sympathetic nerve supply to the bladder?
sympathetic bladder nerve supply = storage, detrusor relaxation
T11-L2
what is the lymph drainage of the bladder
internal iliac nodes
what is the blood supply to the bladder
branches of the internal iliac artery (superior vesicle artery, vaginal artery, minor branches of gluteal and obturator arteries)
What is the orientation of the pudenal nerve in relation to the pudendal artery as it leaves the pelvis
pudendal nerve lies lateral to the pudendal artery as it leaves the pelvis
describe the course of the pudendal nerve as it leaves the pelvis
Pudenal nerve lies lateral to the pudendal artery and leaves the pelvis through the greater sciatic foramen, hooks around the ischial spine and passes under the sacrospinous and then re-enters the pelvis through the lesser sciatic foramen.
when performing a pudendal nerve block what bony landmark should you identify?
ischial spines (as the sacrospinous ligament lies inferior to this bony landmark)
a pudendal nerve block will block sensation to the anterior vagina/mons pubis?
True or false
false - this area is supplied by the genitofemoral and ilioinguinal nerves
is the internal anal sphincter under voluntary or involuntary control
involuntary control
what is the nerve supply to the internal anal sphincter
pelvic splanchic nerves
is the external anal sphincter under involuntary or voluntary control
voluntary control
what is the innervation to the external anal sphincter
inferior rectal branch of the pudendal nerve (S4)
what does version of the uterus refer to
version of the uterus is the angle between the vagina and the cervix
what does flexion of the uterus refer to
uterine flexion is the degree of flexion between the uterus and cervix
what is the degree of anterversion that is normally demonstrated
90 degrees (angle between the vagina and the cervix)
what is the degree of ante flexion of the uterus that is considered normal
120-170 degrees
what are the ovarian arteries branches of?
A - internal iliac arteries
B - external iliac arteries
C- abdominal aorta
D- vaginal arteries
C- Abdominal aorta
(ovarian arteries come directly off the abdominal aorta)
what does the right ovarian vein drain into?
IVC (inferior vena cava)
what does the left ovarian vein drain into?
left renal vein
what is the main blood supply to the uterus
uterine artery
the uterine artery branches off..
A - abdominal aorta
B- internal iliac artery
c- external iliac artery
D- ovarian artery
B- internal iliac artery
what is the venous drainage of the uterus
uterine veins - drain into internal iliac veins
what is the lymphatic drainage of the uterine fundus
para-aortic nodes
what are the two ligaments of the ovary called
- ovarian ligament (medial)
- suspensory ligament of the ovary (lateral)
Which ligament would you find the ovarian arteries and veins
Suspensory ligament of the ovary
what nerve is found in the ovarian fossa
obturator nerve (t10)
what important anatomical structures lie posterior to the ovary
internal iliac artery and ureter
what lymph nodes do the ovaries drain into
para-aortic nodes
what lymph nodes do the fallopian tubes drain into
para-aortic nodes
Pain at the diaphragm can be referred to the shoulder what are the nerve roots that cause this
diaphragm is supplied by S2,3,4 and this is referred to the shoulder (hence why people can present with shoulder tip pain)
A patient has a large amount of free fluid in the Pouch of Douglas secondary to presumed PID. Where might they experience the pain and why?
pain from the pouch of douglas can be referred/transmitted to umbilicus to the anterior thigh (T10-L2)
a patient presents with severe genital HSV surrounding the clitoris, vulva and extends into the vaginal canal. She is experiencing a large amount of her pain down her thighs but can’t understand why. How would you explain this?
referred pain - pain from the cervix and vagina can be referred to the buttock and posterior thighs (s2-s4)
what is the blood supply to the vagina
internal iliac artery branches producing vaginal arteries, uterine arteries, rectal arteries and pudendal arteries
what is the venous drainage of the vagina
venous plexus drains into internal iliac vein
what is the main blood supply to the vulva
pudendal artery (this is the terminal branch of the internal iliac artery)
what nerve provides sensory innervation to the mons pubis and labia majora
A) pudendal nerve
B) ilioinguinal nerve
C) pelvic splanchnic nerve
D) hypogastric nerve
B - ilioinguinal nerve
hence if you do a pudendal nerve block patient will still experience pain and sensation in the anterior vulva
what nerve provides sensory innervation to the lower vagina, perineum and peri-anal area
A) pudendal nerve
B) ilioinguinal nerve
C) pelvic splanchnic nerve
D) hypogastric nerve
A - pudendal nerve
what nerve supplies sensory innervation to the cervix and upper vagina
A) pudendal nerve
B) ilioinguinal nerve
C) pelvic splanchnic nerve
D) hypogastric nerve
C - pelvic splanchnic nerves (S2-s4)
what is the sensory nerve supply to the uterus and adnexa
A) pudendal nerve
B) ilioinguinal nerve
C) pelvic splanchnic nerve
D) hypogastric nerve
D - hypogastric nerve supply sympathetic fibres to the uterus and adnexa
what is the motor innervation to the uterine fundus and body
A) sympathetic
B) parasympathetic
C) pelvic splanchnic nerve
A - sympathetic
what is the motor innervation to the lower uterus and upper vagina
A) sympathetic
B) parasympathetic
C) pelvic splanchnic nerve
B - parasympathetic via uterovaginal nerve plexus (inferior hypogastric nerve)
what is the motor supply to the lower vagina and perineum
A) sympathetic
B) parasympathetic
C) pelvic splanchnic nerve
D - pudendal nerve
pudendal nerve supplies somatic fibres (deep perineal nerve branch)
which of the following uterine ligaments is made from a double layer of peritoneum
A) broad ligament
B) round ligament
C) cardinal ligament
D) uterosacral ligament
E) pubocervical ligament
A - broad ligament
which of the following ligaments is an embryological remnant of the gubernaculum
A) broad ligament
B) round ligament
C) cardinal ligament
D) uterosacral ligament
E) pubocervical ligament
B - round ligament
which of the following ligaments divides the pelvis into anterior and posterior compartments
A) broad ligament
B) round ligament
C) cardinal ligament
D) uterosacral ligament
E) pubocervical ligament
broad ligament (attaches to the lateral pelvic wall)
what are the three divisions of the broad ligament
- mesosalpinx - covers fallopian tubes
- mesovarium - covers the ovary
- mesometrium -covers the uterus, extenal iliac vessels and proximal part of the round ligament of the uterus
which ligament connects the anterior horn of the uterus to the labia major
A) broad ligament
B) round ligament
C) cardinal ligament
D) uterosacral ligament
E) pubocervical ligament
B - round ligament
what canal does the round ligament travel through to reach the labia major
inguinal canal
what nerve does the round ligament lie in close proximity too as it passes through the deep inguinal ring to travel to the labia majora
A - pudendal nerve
B- hypogastric nerve
C- ilioingunal nerve
D- pelvic splanchnic nerve
C - ilioininguinal nerve
which uterine ligament contains the uterine arteries and veins?
A) broad ligament
B) round ligament
C) cardinal ligament
D) uterosacral ligament
E) pubocervical ligament
C = cardinal ligament
(C= contains arteries )
what is the course of the cardinal ligament
cervix to the lateral pelvic wall
do the ureters run
A) anterior to the cardinal ligament
B) posterior to cardinal ligament
C) lateral to cardinal ligemant
D) medial to cardinal ligament
B - posterior to cardinal ligament
which ligament needs to be ligated at oophorectomy and why?
A) broad ligament
B) round ligament
C) cardinal ligament
D) ligament of the ovary
E) suspensory ligament of the ovary
E - suspensory ligament of the ovary as it contains the ovarian artery and vein (+ lymphatics)
which uterine ligament is the anatomical landmark of a pudendal nerve block
A) broad ligament
B) round ligament
C) cardinal ligament
D) uterosacral ligament
E) pubocervical ligament
D - uterosacral ligament
what is the course of the uterosacral ligament
cervix to sacrum
a patient is undergoing diagnostic laprascopy for investigation of pelvic pain ? endometriosis. The trochar has been inserted and the anaesthetist starts becoming concerned as the patient is becoming increasing hypotensive and tachycardia. What vessel could have been damaged?
A) uterine artery
B) abdominal aorta
C) internal iliac artery
D) external iliac artery
E) inferior epigastric artery
B - abdominal aorta
(is at risk from complications of trochar at laprascopy)
a patient develops a rectal sheath haematoma following laparotomy. Which blood vessel is likely to have been damaged during the procedure
A) uterine artery
B) abdominal aorta
C) internal iliac artery
D) external iliac artery
E) inferior epigastric artery
E - inferior epigastric artery
which artery is most vulnerable during episiotomy
A) uterine artery
B) abdominal aorta
C) internal iliac artery
D) pudendal artery
E) inferior epigastric artery
D- pudendal artery
does the uterine artery run anterior or posterior to the ureters
anterior (remember water under the bridge)
what is the lymphatic drainage of the uterine fundus
para-aortic lymph nodes
what is the lymphatic drainage of the ovaries
para-aortic lymph nodes
what is the lymphatic drainage of the fallopian tubes
para-aortic lymph nodes
what is the lymphatic drainage of the upper uterus
superficial inguinal nodes (via the round ligament)
where is the lymphatic drainage of the body of the uterus
external iliac nodes via the broad ligament
where does the lymph drain to from the cervix
external iliac nodes - ultimately para-aortic nodes
where does the lymph drain to from the upper vagina
internal and external iliac lymph nodes
where does the lower vagina lymphatic drain to
superficial inguinal nodes
where does the vulva lymphatic drain to ultimately
femoral nodes (first the superficial inguinal nodes)
what embryological structure are the batholins glands derived from?
urogenital sinus
what are the two erectile tissues called in the male penis (pick 2)
A) corpus spongiosum
B bulbospongiosum
C) corpus cavernosa
D) ischiocavernous
A)corpus spongiosum and C) corpus cavernosa
what happens to blood flow during arousal in the erectile tissues
blood flows into the erectile tissues during arousal to help produce an errection
what are the names of the two muscles that are found in the penis
A) corpus spongiosum
B) bulbospongiosum
C) corpus cavernosa
D) ischiocavernous
B - bulbospongiosum and
D) ischiocavernous
which muscle is responsible for forcing blood into the corpus cavernosa to help maintain an errection
A) corpus spongiosum
B bulbospongiosum
C) corpus cavernosa
D) ischiocavernous
D - ischiocavernous
which muscle is responsible for ensuring the spongy uretra is empty of any residual sperm and urine
A) corpus spongiosum
B bulbospongiosum
C) corpus cavernosa
D) ischiocavernous
B- bulbospongiosum
where does the blood supply to the penis branch from
3 branches of the internal pudendal artery
what are the names of the three arteries that supply the penis
branches of internal pudendal artery
- dorsal artery of the penis
- deep artery of the penis
- bulbourethral artery
what is the venous drainage of the penis
deep and superficial dorsal veins
which nerve is responsible for errection of the penis
A) pudendal nerve (s2-s4)
B) pudendal nerve (T10-L2)
C) pelvic splanchnic nerves (T10-L2)
D) pelvic splanchnic nerves (s2-s4)
D - parasympathetic nerve supply - pelvic splanchnic nerves (S2-S4)
remember point and shoot
which nerve is responsible for ejaculation
A) pudendal nerve (s2-s4)
B) pudendal nerve (T10-L2)
C) pelvic splanchnic nerves (T10-L2)
D) pelvic splanchnic nerves (s2-s4)
A - pudendal nerve S2-s4 (somatic control)
what nerve in males is involved in arousal
A) pudendal nerve (s2-s4)
B) pudendal nerve (T10-L2)
C) pelvic splanchnic nerves (T10-L2)
D) pelvic splanchnic nerves (s2-s4)
A - pudendal nerve under somatic control
During development of an errection what neurotransmitter is responsible for causing vasodilation of the penile arteries
A) noradrenaline
B) adrenaline
C) Acteylcholine
D) nitrous oxide
D - nitrous oxide
causes vasodilation of the penile arteries and so blood flows into the ejaculatory tissues and causes compression of the penile veins
what is the name of the phase that occurs following errection and is responsible for moving sperm from the epididymis to the seminal vesicles
A) stimulation
B) errection
C) emission
D) remission
C - emission
during emission the sperm move from the epididymis to the seminal vesicles getting ready for ejaculation. What neurotransmitter is responsible for co-ordinating the peristaltic contractions
A) noradrenaline
B) adrenaline
C) Acteylcholine
D) nitrous oxide
A - noradrenaline
what prevents retrograde flow of semen into the bladder during ejaculation?
A) noradrenaline causes external urethral sphincter to contract
B) noradrenaline causes internal urethral sphincter to contract
C) Acteylcholine causes internal urethral sphincter to contract
D) nitrous oxide causes internal urethral sphincter to contract
B - noradrenaline causes the smooth muscle of the internal urethral sphincter to contract
A 42-year-old man with type 2 diabetes mellitus is assessed in the neurological clinic. He has recently found that he is incapable of sustaining a penile erection. He is in a long-term relationship with no problems.
Which of the following nerves is most likely to have suffered damage in the course of long standing disease?
A. Dorsal nerve of the penis
B. Hypogastricnerve
C. Pelvic splanchnic nerve
D. Perineal nerve
E. Sacralsplanchnicnerve
c. pelvic splanchnic nerve
testicular arteries are
A) branch directly of the aorta
B) branch of internal iliac artery
C) branch of external iliac artery
D) branch of pudnendal nerve
A - branch directly of the aorta
what hormone do serotoli cells secrete
A) testosterone
B) inhibin
C) oestrogen
D) progesterone
B - inhibin
what hormone do leydig cells secrete
A) testosterone
B) inhibin
C) oestrogen
D) progesterone
A - testosterone
what type of receptors do leydig cells have
A) FSH receptors
B) LH receptors
LH receptors
what type of receptors do sertoli cells have
A) FSH receptors
B) LH receptors
FSH receptors
