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MRCS Part A (KF edition) > Pelvic anatomy > Flashcards

Pelvic anatomy Flashcards

1
Q

What structures lie posterior to the kidneys?

A
  • Quadratus lumborum
  • Diaphragm (arcuate ligament)
  • Psoas major
  • Transversus abdominis
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2
Q

What is the arrangement of structure in the pedicle of the kidney?

A

VAP

  • Renal vein (Anterior)
  • Renal artery (Middle)
    -Pelvis of ureter (posterior
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3
Q

At which vertebral levels do the renal arteries arise?

A

Right renal artery - L2

Left renal artery - L1

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4
Q

What are the anatomical relations of the right adrenal gland?

A

Anterior: hepato-renal pouch and bare area of the liver

Inferior: kidney

Posterior: Diaphragm

Medial: IVC

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5
Q

What are the 3 zones of the prostate?

A
  • Transitional zone: surrounds urethra (most common site for BPH)
  • Central zone: surrounds the ejaculatory duct
  • Peripheral zone: surrounds the other 2 zones (70% of prostatic cancer)
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6
Q

What are the sub divisions of the cortex and what do they each produce?

A

From superficial to deep

Zona Glomenulos - Mineralocorticoids e.g. Aldosterone

Zona Fasciculata - glucocorticoids e.g. cortisol

Zona Reticularis - sex hormones e.g. androgens & oestrogen

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7
Q

What is the bony landmark of the vesico-ureteric junction?

A

Ischial spine

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8
Q

What is the relation of the. ureter to the gonadal vessels?

A

Lateral, posterior and then medial (at the bifurcation of the common iliac artery)

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9
Q

What is the histological structure of the prostate?

A

Glandular and smooth muscle elements

(does NOT have a true capsule but an outer condensed fibro-muscular band which is an inseparable component)

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10
Q

Which zone of the prostate does BPH most often affect?

A

Transitional zone (medial lobe)

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11
Q

Which zone of the prostate is most often affected during prostate cancer?

A

Peripheral zone (70% of prostate cancers)

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12
Q

What is the blood supply of the prostate?

A

Inferior vesicle artery AND middle rectal artery (anterior division of Internal iliac artery)

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13
Q

What is the venous drainage of the prostate?

A

Prostatic venous plexus of Santorini

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14
Q

In a DRE what will you find antreriorly and posteriorly in males?

A

Anteriorly: prostate

Posteriorly: Puborectalis (part of anal sphincter)

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15
Q

In a PV examination, what will be palpated anteriorly?

A

Base of the bladder

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16
Q

What are the angles of the bladder and what is their significance?

A

Apex: attached to the median umbilical ligament (if patent can cause urachal sinus)

Neck: lies on prostate (males) or Pelvic fascia (females)

2 postero-superior angles: receives the 2 ureters

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17
Q

What is the trigone?

A

Triangular part at the base between the 2 openings of the ureter and the opening of the urethra

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18
Q

What is the arterial supply of the bladder?

A

Vesical arteries (anterior division of internal iliac artery)

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19
Q

What is the sympathetic and parasympathetic supply of the bladder?

A

Parasympathetic: S2, 3, 4 (motor to wall and relaxation of sphincter)

Sympathetic: T11 - L2 (inhibition of wall and contraction of sphincter)

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20
Q

What is the embryological origin of the urethra and what does malformation of this structure cause?

A

Urethra is a subdivision of the Cloaca

Malformation of the cloaca will lead to vesical-ureteric fistula

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21
Q

What is the average lengths of the male and female urethra?

A

Male: 15-20cm

Female: 4cm

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22
Q

How many parts does the male urethra consist of?

A

4 parts

  • Pre-prostatic urethra
  • Prostatic urethra: widest and most dilatable part. receives input from ejaculatory duct
  • Membranous urethra: surrounded by striated external sphincter. Narrowest and least dilatable part
  • Penile urethra: poorly muscularised. Traverses corpus spongiosum to open at tip of glans penis
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23
Q

Which part of the urethra receives input from the ejaculatory duct?

A

Prostatic urethra

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24
Q

What are clinical signs of bladder injury?

A
  • Anuria
  • Puritanism (or at least lower abdominal pain)

Investigated by anterograde cystogram

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25
Q

What are the 2 main sites of urethral injury and how can a diagnosis be made?

A
  • Membranous urethra: high riding prostate

Bulba urethra: pt will presents with legs apart

Diagnosed by retrograde cystogram

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26
Q

What are the 3 layers that cover the spermatic cord?

A
  • External spermatic fascia (ext. oblique aponeurosis)
  • Cremasteric fascia (int oblique)
  • Internal spermatic fascia (transversalis fascia)
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27
Q

Which vein and structure is involved in formation of a varicocele?

A

Defect in testicular vein OR Pampiniform plexus (plexus drains into testicular vein)

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28
Q

What are the 8 structures that are present in the spermatic cord?

A
  • Vas deferens
  • Testicular artery (branch of AA)
  • Artery of vas def
  • Cremasteric artery (from inferior epigastric artery)
  • Pampiniform plexus
  • Sympathetic nerve fibres (lies on arteries)
  • Genital branch of genitofemoral nerve
  • lymphatic vessels
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29
Q

What are the layers of the scrotum?

A

From inside to out

  • Tunica Albuginea (fibrous)
  • Visceral layer of tunica vaginalis (from peritoneum)
    Parietal layer of tunica vaginalis (from peritoneum)
  • Internal spermatic fascia (fascia transversalis)
  • Cremasteric fascia (Int. oblique)
  • External spermatic fascia (Ext. oblique)
  • Dartos muscle
  • Skin
30
Q

Where does the Tunica vaginalis originate from?

A

Peritoneum

31
Q

What scrotal layer surrounds a hydrocele?

A

Tunica vaginalis

32
Q

Where does the Dartos muscle arise from?

A

Superficial fascia

33
Q

Where would a collection or swelling surrounding the Dartos muscle present?

A

Subcutaneously

34
Q

What is the anterolateral sensation of the scrotum supplied by?

A

Genitofemoral nerve (L1-L2)

35
Q

What is the anterior sensation of the scrotum supplied by?

A

Ilioinguinal nerve

36
Q

What is the inferior and posterior sensation of the scrotum supplied by?

A

Posterior: Pudendal nerve (S2- S4)

Inferior: Posterior femoral cutaneous nerve

37
Q

What is the lymphatic drainage site of the scrotum?

A

Superficial horizontal inguinal nodes

38
Q

What is the lymphatic drainage of the testis and ovaries?

A

Para-aortic nodes

(as they receive blood supply from aorta)

39
Q

What is the lymphatic drainage of the scrotum, labia major and lower anus?

A

Superficial horizontal inguinal lymph nodes

40
Q

What is the most important tendinous support of the uterus?

A

Central perineal tendon

41
Q

What is the lymphatic drainage of the fundus of the uterus?

A
  • Para-aortic nodes
  • Inguinal lymph nodes (via round ligament)
42
Q

What is the lymphatic drainage of the body of the uterus?

A

External iliac node (via broad ligament)

43
Q

What is the lymphatic drainage of the cervix?

A
  • Ext. iliac node
  • Int. iliac node
  • Presacral nodes
44
Q

What is the lymphatic drainage of the prostate and bladder?

A

Internal iliac nodes and then drains into sacral nodes

45
Q

What are the boundaries of the Ischiorectal fossa?

A

Medial wall: Levator ani muscle and anal canal

Lateral wall: Obturator internus (covered with fascia)

Base: Skin of perineum

46
Q

What are the contents of the ischiorectal fossa?

A
  • Dense fat
  • Pudendal nerve and internal pudendal vessels (in the pudendal canal)
  • Inferior rectal nerve (arises from pudendal nerve) + vessels (cross fossa to reach anal canal)
47
Q

What are the 3 branches of the pudendal artery?

A
  • Inferior rectal artery
  • Dorsal artery of clitoris
  • Perineal artery (supplies penis and labia)
48
Q

Where is the deep perineal pouch and what structures are found here?

A

Area between perineal membrane (below) and superior fascia of urogenital diaphragm (above)

Structures found in females:
- Vagina
- Urethra
- Sphincter membrane
- dorsal nerve of clitoris (from pudendal)
- dorsal/deep arteries clitoral arteries (from pudendal artery)

Structures found in males:
- Bulbourethral glands (lie below sphincter urethrae muscle. secretions released during erotic stimulation)
- Internal pudendal artery (gives rise to artery to bulb, deep artery of penis, dorsal artery of penis)
- Dorsal nerve of penis (passes on each side through deep perineal pouch to supply skin of penis)

49
Q

Where is the superficial perineal pouch?

A

everything below the perineal pouch

50
Q

What is the normal pathway of testis descent?

A

Deep inguinal ring –> Superficial inguinal ring –> Inguinal canal –> Upper part of the scrotum

51
Q

What is the most common site for an ectopic testis?

A

Superficial inguinal pouch

52
Q

What is the name of the fascia that is found anterior to the rectum between the rectum and prostate?

A

Denovilliers fascia

53
Q

Where is Waldeyers fascia found?

A

Posterior ano-rectal

54
Q

What are the features of a female pelvis that differ from a male pelvis?

A
  • Wider and shallower
  • Ischial tuberosities are further apart
  • Oval shaped in females
  • Sacrum is less curved
55
Q

What is the lymphatic drainage of the upper and middle rectum?

A

Pararectal and Inferior mesenteric lymph nodes

56
Q

What is the lymphatic drainage of the lower rectum?

A

Sacral group OR Internal iliac lymph nodes

57
Q

What is the lymphatic drainage of the anal canal below the dentate line?

A

Inguinal and external iliac nodes

58
Q

What is the lymphatic drainage of the anal canal above the dentate line?

A

Mesorectal / Internal iliac nodes

59
Q

What is the origin and termination of the abdominal aorta?

A

T12 to L4

60
Q

What are the anterior relations of the abdominal aorta?

A
  • Lesser omentum
  • Liver
  • Left renal vein
  • Inferior mesenteric vein
  • 3rd part of the duodenum
  • Pancreas
  • Parietal peritoneum
  • Peritoneal cavity
61
Q

What are the right lateral relations of the abdominal aorta?

A

-Right crus of the diaphragm
- Cisterna chyli
- IVC (becomes posterior distally)

62
Q

What are the left lateral relations of the abdominal aorta?

A
  • 4th part of the duodenum
  • Duodenal-jejunal flexure
  • Left sympathetic trunk
63
Q

At which level does the phrenic arteries arise?

A

T12 (upper)

64
Q

At which level does the coeliac axis arise?

A

T12

65
Q

At which level does the median sacral and common iliac artery arise?

A

L4

66
Q

What is the course of the common iliac artery?

A

Begins at L4, travels downwards laterally at the medial border of the poses muscle. Ends at the sacroiliac joint where it divides into Int and Ext

67
Q

What is the course of the external iliac artery and what are its branches?

A

Begins at the sacroiliac joint and ends at the mid-inguinal point where it continues as the femoral artery of the thigh

Branches:
- Inferior epigastric artery (medial wall of internal ring)
- Deep circumflex iliac artery

68
Q

Where does the IVC originate and end?

A

Begins at L5 (union of common iliac veins behind the RIGHT common iliac artery

Ends at the level of T8 (pierces central tendon of the diaphragm)

69
Q

At T8, which structures drain into the IVC?

A

Hepatic vein
Inferior phrenic vein

70
Q

At which level do the suprarenal and renal veins drain into the IVC?

A

L1

71
Q

Which veins unify to become the portal vein?

A

SMV and splenic vein

72
Q

In the correct order, from superficial to deep, what layers do you pass through during an LP?

A

At level L4/L5

  • Skin, fat, fascia
  • Supraspinous ligament
  • Interspinous ligament
  • Ligamentum flavum (strongest ligament)
  • Epidural space
  • Dura matter
  • Arachnoid matter
  • CSF

MRCS Part A (KF edition) (18 decks)

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