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Anatomy > Pelvis > Flashcards

Pelvis Flashcards

1
Q

AP diameter limits

A

Midpoint sacral promontory

Upper border pubic symphysis

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2
Q

Transverse diameter limits

A

Two similar points on opposite sides of pelvic brim

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3
Q

Oblique diameter limits

A

Ilio pubic eminence to lowest point of cobra lateral sacroiliac joint

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4
Q

Pelvis brim/ inlet borders

A

Sacral ala and promontory posterior
Arcurate line laterally and pectineal line anterolaterally
Superior pubic rami, body of pubis and pubic symphysis anteriorly

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5
Q

4 elements of pelvic outlet

A

Coccyx posteriorly
PS anteriorly
2 ischial tuberosities laterally

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6
Q

Insertions of sacrotuberous ligaments

A

Sacrum coccyx

Ischial tuberosities

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7
Q

Shape of inlet

A

Wide transverse oval

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8
Q

Position if fetal head entering pelvis

A

AP diameter across transverse diameter of pelvis

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9
Q

Articulations of the pelvis

A

Sacroiliac joints
Between sacrum and coccyx
Symphysis pubis

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10
Q

Ligaments of sacroiliac joint

A

Ventral (thickening of joint capsule)
Dorsal
Interosseus

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11
Q

Dorsal sacroiliac ligament attachments

A

Intermediate/lateral crests of sacrum
Pass down to
PSIS and inner lip of iliac crest

Lower part may form a separate structure - long posterior SI ligament

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12
Q

Interosseus ligament attachments

Which ligament covers the interosseus?

A

From depressions on sacrum to depressions on iliac tuberosity
Deep and superficial strata
Covered by dorsal SI ligament
Dorsal primary rami of sacral nerves and vessels between

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13
Q

Ligament formed by superficial fibres of interosseus

A

Short posterior iliac

Between superior articular process and lateral crest of first two sacral segments to the ilium

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14
Q

Pubic symphysis joint type

A

Secondary cartilaginous

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15
Q

Symphysis pubis structure

A

Fibrocartilaginous disc
Superior pubic ligament
Arcuate pubic ligament

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16
Q

Between which structures does the deep vein of the clitoris enter the pelvis?

A

Urogenital diaphragm and arcuate pubic ligament

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17
Q

Muscles of the anterior abdominal wall and importance in labour

A

External oblique
Internal oblique
Transversus abdominus
Rectus abdominus

Obliques act in compression

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18
Q

Attachments of external obliques

A

Outer surface lower 8 ribs
Fibres interdigitate with serratus anterior and lat dorsi
Fibres from lower 2 ribs pass vertically down to anterior part of iliac crest, from others down and medial becoming aponeurotic level with tip of 9th rib

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19
Q

Site of interdigitate on of two external obliques

Limits of this structure

A

Linea alba, tendinous raphe

Xiphoid process to pubic symphysis

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20
Q

Components of lines alba

A

2 obliques
Transversus abdominus
Interrupted by umbilicus

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21
Q

Structures transmitted by umbilicus

A

Umbilical vessels –> medial UL and ligamentum teres
Vitelline duct
Urachus –> median UL

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22
Q

Position of lower fibres of external obliques aponeurosis

A

ASIS to pubic tubercle

Thickened and folded in on itself to form floor of inguinal canal

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23
Q

Lacunar ligament position and structure

A

Fibres from medial end of inguinal ligament pass backwards and medially to pectineal line
Forms medial boundary of femoral ring

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24
Q

Internal oblique attachments

A

Thinner than external
Arises from lumbar fascia, lateral inguinal ligament and anterior iliac crest
Posterior fibres ascend vertically to lower ribs (continuous with external intercostals)
Fibres from iliac crest pass up and medial meeting in midline at linea alba
Fibres from inguinal ligament arch down and medially crossing round ligament, become aponeurotic. Insert behind round ligament to pubic crest and medial pectineal line together with similar fines from transversus abdominus forming falx inguinalis (conjoined tendon) behind superficial inguinal ring

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25
Q 
Falx inguinalis:
Alternative name
Components
Function
Position
A

Conjoined tendon
Internal oblique fibres from lateral inguinal ligament passing down and medially
Transversus abdominus fibres
Medially continuous with anterior wall of rectus sheath
Lies behind superficial inguinal ring
Strengthens weak point of abdominal wall
Occasionally continuous laterally with band of aponeurotic fibres - interfoveolar ligament giving additional strength (fibres from lower border transversus abdominis to superior pubic ramus)

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26
Q

Transversus abdominis origin

A

Deep to internal oblique from lumbar fascia, lateral inguinal ligament and anterior iliac crest
ALSO fibres arise from inner lower 6 ribs and interdigitate with diaphragm

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27
Q

Transversus abdominis fibre orientation

A

Horizontal

Meeting in midline at linea alba

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28
Q

Transversus abdominus fibres passing behind rectus

A

Aponeuroses in upper 4/5

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29
Q

Transversus abdominus fibres passing in front of rectus abdominis

A

Lower 1/5 arising from inguinal ligament and iliac crest

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30
Q

Rectus abdominis origin and insertion

A

Crest and tubercle of pubis

Broadens and inserts onto ribs 5-7

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31
Q

3 transverse tendinous intersections of recti muscles

A

Level of xiphoid process
Umbilicus
Midway between these two

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32
Q

Rectus sheath components in upper part

A

Aponeuroses of the obliques muscles and transversus abdominis
Transversus aponeurosis lies posterior
Internal oblique divides into two laminae - one deep and one superficial to muscle
External oblique aponeurosis lies anterior
Medial to the recti muscles the aponeurotic layers reunite to form the linea alba

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33
Q

Point of change in structure of rectus sheath

Component of rectus sheath posteriorly below this point

A

Midway between symphysis pubis and umbilicus at the arcuate line
Transversal is fascia deep to transversus abdominus

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34
Q

Point of access of inferior epigastric vessels to rectus sheath

A

Arcuate line

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35
Q

Position of transversal is fascia

A

Between transversus abdominis and parietal peritoneum

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36
Q

Plane of lower 6 intercostal nerves

A

Between transversus abdominis and internal oblique

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37
Q

Position of inguinal canal

A

Between abdominal cavity and labia majora, obliquely between superficial and deep inguinal rings
Just superior to medial half of inguinal ligament

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38
Q

Contents of inguinal canal

A

Round ligament of uterus

Ilioinguinal nerve

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39
Q

Boundaries of inguinal canal

A

Floor: inguinal ligament united with transversalis fascia
Roof: arching fibres of transversus abdominis and internal oblique
Anterior: skin, superficial fascia, external oblique aponeurosis; fibres of internal oblique also contribute to most lateral part
Posterior: transversalis fascia, reinforced by conjoint tendon and reflected part of inguinal ligament

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40
Q

Deep inguinal ring components and position

A

Transversalis fascia
Midway between ASIS and pubic symphysis
Transversus abdominus fibres arch over superiorly
Inferior epigastrics immediately medial
Internal oblique contraction with increased intra abdominal pressure acts as valve to close deep inguinal ring

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41
Q

Superficial inguinal ring components and position

A

Above inguinal ligament
Just lateral to pubic tubercle
Opening in aponeurosis of external oblique, margins thickened to form lateral and medial crura of the ring

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42
Q

Round ligament covering

A

Internal spermatic fascia as passes through transversalus fascia at level of deep ring
Cremasteric fascia on passing through internal oblique
External spermatic fascia as external oblique aponeurosis
Ilioinguinal nerve accompanies round ligament

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43
Q

Round ligament course

A

Through transversalis fascia at deep inguinal ring

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44
Q

Ilioinguinal nerve origin

A

Anterior primary ramus L1

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45
Q

Course of ilioinguinal nerve

A

Emerges from lateral psoas border
Crosses qudratus laborum
Perforated transversus abdominis close to anterior iliac crest
Runs in this plane until piercing internal oblique
Enters inguinal canal
Emerges through superficial ring
Distributed to skin of medial thigh, mond pubis and labia majora.
Also supplies IO and TA muscles

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46
Q

Which structure does damage to the ilioinguinal nerve weaken?

A

Conjoint tendon due to contribution of IO and TA muscle fibres which it supplies
This can result in a direct hernia

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47
Q

Structure of superficial fascia of inguinal region

A

2 layers
Superficial continuous with abdominal superficial fascia
Deep fuses with fascia lata (deep fascia of thigh) just below inguinal ligament and contributes to saphenous opening

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48
Q

Structures lying between superficial and deep layers of inguinal region fascia

A

Superficial inguinal nodes

Long saphenous vein

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49
Q

Facia lata thickening forms wich tract?

A

Iliotibial

Proximal and lateral thickening

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50
Q

Bladder innervation
1.
2.

A
  1. Fine medullated fibres from S3,4

2. Non-medullated fibres from hypo gastric plexus

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51
Q

Connects bladder to pelvic wall

A

Fascia endopelvina

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52
Q

Course of urachus

A

Vertex of bladder to umbilicus

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53
Q

Level of the tendinous arch

Another name for this structure

A

Line extending from lower part if symphysis pubis to ischial spine in upper diaphragmatic part of pelvic fascia
White line of the pelvic fascia

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54
Q

Attachments of superficial layer of fascia lata

A

Entire length of inguinal ligament
ASIS
Pectineal line of pubis

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55
Q

Position of superficial fascia lata

A

Lateral to saphenous opening
Reflected inferolaterally from pubic tubercle forming falciform margin of opening
SL

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56
Q

Position of deep layer fascia lata

A

Medial to saphenous opening
Continuous with superficial layer at lower margin
Continues upwards to cover adductors, behind femoral sheath and attaches to pectineal line

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57
Q

Relation if fascia lata layers to femoral sheath

A

Superficial layer anterior

Deep layer fascia

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58
Q

Components of femoral sheath

A

Transversalis fascia anterior to femoral vessels
Iliacus muscle behind these vessels
Layers terminate by fusing with fascia on the outer layers of the femoral vessels

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59
Q

Shape of femoral sheath

A

Funnels shaped, wider at proximal end

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60
Q

Which nerve pierces lateral wall of femoral sheath?

A

Femoral branch of genitofemoral

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61
Q

Which vessel pierces medial wall of femoral sheath?

Which vessel does this drain into?

A

Great saphenous vein

Femoral vein

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62
Q

Boundaries if femoral triangle
Superior
Lateral
Medial

A

Inguinal ligament
Medial border sartorius
Medial border adductor longus
ILSAL

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63
Q

Components of femoral triangle floor

A

Lateral border adductor longus
Iliacus
Psoas major
Pectineus

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64
Q

Contents of femoral sheath from medial to lateral

Immediate lateral relation to sheath

A

Femoral canal
Femoral vein
Femoral artery

Femoral nerve

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65
Q

Contents of femoral canal

A

Lymph vessels

Deep inguinal lymph nodes

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66
Q

Proximal opening of femoral canal

Medial aspect of this opening

A

Femoral ring

Lacunar ligament

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67
Q

Origin and termination of round ligament

A

Uterine fundus

Labia majora

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68
Q

Relation of round ligament to Fallopian tube

A

Inferior and anterior

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69
Q

Path of the round ligament

A

Arises from uterine fundus inferior and anterior to Fallopian tube
Runs through broad ligament passing over external iliac vessels and psoas muscle
Through inguinal canal
Fibres fan out to form labium majora

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70
Q

Obturator foramen shape in male/female

A

More triangular in female, ovoid in male

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71
Q

Supra pubic arch in male/female

A

50-60 degrees

80-85 degrees

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72
Q

Orientation of iliac blades in female

A

More vertical that male

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73
Q

Reasons femoral hernias more common in women

A

Femoral ring larger

Due to greater width of pelvis and smaller femoral vessels

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74
Q

Which structure lies lateral to femoral sheath?

A

Femoral nerve

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75
Q

Which structure passes over the femoral vein just above the femoral ring?
Where is this structure travelling?

A

Round ligament as it enters the deep inguinal ring

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76
Q

2 groups of pelvic muscles

A

Obturator internist and piriformis line the walls

Pelvic diaphragm or floor: levator ani and coccygeus

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77
Q

Bony attachments of levator ani

Origin of fibres between these points

A

Pubic bone inner surface
Spine if ischium medial aspect
Fascia overlying obituary or externus

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78
Q

Name of anterior part if levator ani

Origin and direction if fibres

A

Originate at body of pubis
Pass A-P to perineal body
Pass across sides of vagina (form a supplementary sphincter)
Insert into anterior surface of coccyx

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79
Q

Name of anterolateral part of levator ani

Origin and direction of fibres

A

Puborectalis
Fibres arise more laterally than pubovaginalis
Pass back, down and medially meeting fibres from opposite side
Form sling round junction between rectus and anus
Fibres intermingle with deep fibres of EAS and perineal body

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80
Q

Iliococcygeus origin and insertion

A

Medial aspect ischial spines

Pass lateral to medial

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81
Q

Fascial covering of levator ani
Which fascia does this contribute to?
Which other structure does this give rise to?

A

Superior fascia of pelvic diaphragm
Fascia covering obituary or internist above
Tendinous arch of the levator ani

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82
Q

Which structure does the tendinous arch of the pelvic fascia give rise to?

A

Attachment of the lateral supporting ligament if the urinary bladder

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83
Q

Which artery supplies levator ani?

A

Inferior gluteal

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84
Q

Components if levator ani

Function

A

Iliococcygeus
Pubococcygeous
Puborectalis

Supports pelvis viscera
Constricts rectum and vagina

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85
Q

Innervation of levator ani

A

Pudendal nerve
Perineal nerve
Inferior rectal nerve
Sacral spinal nerves S3, S4

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86
Q

Coccygeus origin and insertion

A

Ischial spine and deep surface of sacrospinous ligament

Coccyx and lateral margin 5th scral segment

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87
Q

Vertebral level of common iliacs

A

L4-L5

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88
Q

How much longer is R common iliac than L?

Which vertebra does it pass directly in front of?

A

1cm

L5

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89
Q

What separates common iliacs from small intestine?

A

Parietal peritoneum

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90
Q

Which muscle lies laterally to common iliacs?

A

Psoas

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91
Q

Which nerve fibres form a mesh work over common iliacs?

A

Superior hypogastric plexus

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92
Q

Common iliac veins unite to form which vessel?

A

IVC

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93
Q

Relation of left common iliac artery to vein

A

Anterolateral

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94
Q

Level of division of common iliacs

A

Sacroiliac joint

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95
Q

Which muscle is external iliac related to?

A

Medial border of psoas

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96
Q

Which structure does external iliac artery pass under to enter thigh?
At what landmark?

A

Inguinal ligament

Midway between PS and ASIS at Mid inguinal point (1cm medial to midpoint of inguinal ligament)

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97
Q

Which structure crosses anteriorly at point of division of common iliac artery?

A

Ureter

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98
Q

Where do internal iliacs divide into anterior and posterior divisions?

A

Upper margin of greater sciatic notch

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99
Q

Which foramen does posterior internal iliac pass through?

A

Greater sciatic

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100
Q

Terminal branches of posterior division of external iliac

A

Superior gluteal
Lateral sacral
Iliolumbar

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101
Q

Anterior division of internal iliac direction

A

Towards ischial spine

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102
Q

Anterior relations of anterior division of internal iliac at division

A

Ureter
Ovarian artery
Film brisk end of tube
Ovary

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103
Q

Relation of internal iliac veins to internal iliac arteries

A

Posterior

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104
Q

Relation of external iliac veins to external iliac arteries

A

Below and medial

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105
Q

Relation of obturator nerve to psoas muscle and division of common iliac

A

Emerges from medial aspect of psoas lying first at the division
Then on pelvis side wall above obturator vessels before passing through obturator canal to enter medial compartment of thigh

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106
Q

Umbilical artery is a branch of ___?
What does it supply?
What happens at its distal end

A

Internal iliac
Umbilical artery –> superior vesical branches Supply superior aspect of bladder and distal ureter
Becomes fibrous, ascends to umbilicus covered in parietal peritoneum and raises a fold on each side of inner surface of abdominal wall - medial umbilical ligament

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107
Q

Branches of internal iliac artery

A

Obturator
Umbilical –> superior vesical and medial umbilical ligament
Uterine and vaginal
Middle rectal (can be elusive, arises in common with inferior vesicle) –> lower rectum
Inferior vesical –> fundus of bladder, distal ureter
Internal pudendal
Inferior gluteal

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108
Q

Path of obturator artery

Relation to obturator nerve

A

Passes forward on lateral pelvic wall to enter obturator canal 2-3cm below pelvic brim
Lies inferior to nerve in canal

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109
Q

Path of uterine artery

A

First lies on fascia over levator ani
Turns medially towards cervix crossing above and in front of ureter
Ascends in broad ligament to junction of uterine body and tube
Branches turn laterally to anastomose with ovarian artery

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110
Q

Blood supply of vagina

A

Branches if uterine artery (from internal iliac anterior branch)

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111
Q

Terminal branches if internal iliac

Which is the larger?

A

Internal pudendal

Inferior gluteal larger

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112
Q

Path of internal pudendal artery

A

Leaves pelvis through lower greater sciatic foramen between coccygeal and piriformis
Winds around ischial spine between pudendal nerve medially and nerve to obturator internus laterally
Enters perineum through lesser sciatic foramen
Lies in pudendal (Alcock’s) canal within the perineum

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113
Q

Location of pudendal canal
Alternative name
Relation with other fascia

A

Lateral wall of ischioanal fossa (Alcock’s)
Fascias sheath forms roof and lateral wall of fossa
Fuses with part of obturator fascia
Continuous with inferior fascia of pelvic diaphragm and falciform process if sacrotuberous ligament

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114
Q

Which structures accompany internal pudendal artery in the pudendal canal?
Which artery branches from internal pudendal at start of canal?

A

Pudendal nerve - lies between terminal branches at the anterior end (dorsal nerve of clitoris above and perineal nerve below)
2 veins
Inferior rectal

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115
Q

Origin of inferior rectal artery

Structures supplied by it

A

Internal pudendal artery
Just superior to ischial tuberosity emerges from medial wall of sheath crossing ischioanal fossa
Supplies skin and muscles of anal region

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116
Q

Which arteries arise from internal pudendal?

A

Inferior rectal

Perineal

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117
Q

Path of the perineal artery

A

Arises from pidendal at anterior end of pudendal canal

Through inferior fascias layer of urogenital diaphragm to enter superficial perineal space

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118
Q

Path of inferior gluteal artery

A

Larger terminal branch of internal iliac
Leaves pelvis posterior to internal pudendal
Also passes between piriformis and coccygeus in lower greater sciatic foramen
Supplies gluteal region and posterior thih structures

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119
Q

Pelvic lymphatic drainage
Which structures does this include?

Which structures have different drainage?

A

Passes to nodes along internal iliac veins
To paravertebral or lateral aortic nodes in lateral aspects if vertebral bodies (also receive lymph from ovaries/kidneys/adrenals/posterior abdo wall muscles)
To cisterna chyli posterior to aorta at L1-L2
To thoracic duct

Uterus and vagina

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120
Q

Which plexuses inner ate the pelvis?

A

Lumbar and sacral

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121
Q

Which nerves form the lumbar plexus?

Where is this plexus formed?

A

Anterior primary rami of T12-L4

Within substance of psoas major

122
Q

Which nerves does the lumbar plexus give rise to?

A 
Femoral - posterior divisions L2,3,4
Obturator - anterior divisions L2,3,4
Subcostal 
Iliohypogastric
Ilioinguinal
Genitofemoral
123
Q

Path of femoral nerve

A

Emerges lateral psoas
Runs between psoas and iliacus until inguinal ligament
Passes on anterior surface of iliopsoas as this muscles passes under inguinal ligament
Separated by psoas from external iliac and femoral artery by psoas superiorly but immediately lateral to femoral artery in the thigh

124
Q

Divisions of femoral nerve

A

Within pelvis supplies iliacus and nerve to pectineus (from medial aspect near inguinal ligament, passes behind femoral sheath)
In thigh divides into anterior and posterior to supply muscles and skin

125
Q

Path of obturator nerve

A

Emerges from medial border of psoas (OM, FL)
Lies behind common iliacs at pelvic brim
Continues lateral to internal iliacs on obturator internus
Above obturator artery through obturator canal
Exits pelvis to supply adductors and skin of medial thigh

126
Q

Why can pain from the ovary be referred to the medial thigh?

A

Parietal peritoneum near ovary is also supplied by obturator nerve

127
Q

Path of subcostal and iliohypogastric

A

Cross quadratus lumborum
Pierce transversus abdominis
Run in neurovascular plane between transversus abdominis and internal oblique

128
Q

What structures are supplied by the subcostal and iliohypogastric nerves?
What is the origin of these nerves?

A

Transversus abdominis
Internal oblique
Skin of lower abdomen
Lumbar plexus

129
Q

Path of genitofemoral nerve

Structures supplied by it

A

Anterior surface if psoas
Divides into femoral and genital branches
Femoral branch passes below inguinal ligament to supply skin over femoral triangle
Genital branch passes through deep inguinal ring to supply cremaster

130
Q

What structure unites lumbar and sacral plexuses?

Which roots?

A

Lumbo sacral trunk (L4-5)

131
Q

Path of lumbo sacral trunk

A

Medial to psoas
Crosses pelvic brim anterior to SIJ
Joins ventral primary ramus of S1

132
Q

Which nerves form sacral plexus?

A

Lumbo sacral trunk

Anterior primary rami S1-4

133
Q

Location of sacral plexus

A

On piriformis behind internal iliacs, ureter and gut

134
Q

Structure formed by upper group of sacral plexus

Roots

A

Sciatic nerve

L4-S2 and part of S3

135
Q

Structure formed by lower group of sacral plexus

Roots

A

Pudendal nerve

Mainly S3-4 (small contribution S2)

136
Q

Nerve supply of piriformis

A

Sacral plexus

Via nerve that exits at S1-2 and enters anterior surface

137
Q

Nerve supply of levator ani

A

Sacral plexus

Through branches derived from S4

138
Q

Pudendal nerve roots

Path of pudendal nerve

A

S2,3,4
Leaves pelvis through GSF
Winds around ischial spine medial to IPA just deep to sacrospinous ligament and close to ischial spine
Enters perineum through LSF into pudendal (Alcock’s) canal

139
Q

Structures supplied by pudendal nerve

A

Vulva

Perineum

140
Q

Branches and supply of pudendal nerve

A

Inferior rectal nerve –> EAS, lining of distal anal canal, perineal skin, sensory fibres to lower part of vagina

Terminal branches
Perineal nerve –> posterior labial branches
Dorsal nerve of clitoris

141
Q

Which structure is the pudendal needle passed through for nerve block?

A

Sacrospinous ligament

142
Q

Sympathetic supply of pelvis

A

Thoracolumbar

Thoracic via greater and lesser splanchnic nerves - preganglionic arise in thorax but synapse in ganglia related to aortic branches

143
Q

Greater splanchnic nerve components and path

A

Preganglionic sympathetics from T5-9(10), also visceral afferents
Passes through diaphragm
Contributes to coeliac ganglion

144
Q

Lesser splanchnic nerve components and path

A

T9-10(11) sympathetic ganglia

Passes to aorticorenalganglion

145
Q

How many ganglia does sympathetic chain consist of in lumbar region?

A

4
Lie on lateral aspect of lumbar vertebrae
Sympathetic fibres distribute to pelvis via superior hypo gastric plexus (pre sacral nerves)

146
Q

Location of superior hypo gastric plexus
2 main trunks carrying symp fibres
Relation of trunks to internal iliacs
Origin of parasympathetic fibres in the plexus

A

Anterior to aortic bifurcation
Right and left hypo gastric nerves
Medial
Pelvic splanchnic nerves S2-4, ascend from inferior hypogastric plexus, usually to L side of plexus

147
Q

Where do the hypogastric nerves send sympathetic fibres to?

Where do these fibres originate?

A

Ovarian and ureteric plexuses

Renal and aortic sympathetic plexuses

148
Q

Another name for inferior hypogastric plexus
Structure
Origin of parasympathetic fibres

A

Pelvis plexus
Continuation of R and L hypogastric nerves
Pelvic splanchnic nerves S2-4 of sacral plexus

149
Q

Which structures do pelvic splanchnic nerves supply?

What type of innervation?

A

Pelvic viscera and hindgut

Parasympathetic

150
Q

Location if inferior hypogastric plexus

A

Within fascia surrounding rectum

Fibres lie on either side of rectum, cervical and vaginal fornices and posterior aspect bladder

151
Q

Which structures does the inferior hypogastric plexus supply?
Where are the fibres from?

A

Pelvic viscera
Broad ligament –> uterovaginal plexus

T10-L2 of cord
Preganglionic PS fibres if pelvic splanchnic nerves

152
Q

Origin of fibres of uterovaginal plexus

Destination of fibres from uterovaginal plexus

A

Inferior hypogastric/pelvis plexus
Some travel with uterine and vaginal arteries, others directly to cervix

Fibres travelling with uterine arteries supply body of uterus, upper broad ligament and tubes
Fibres with vaginal supply walls if vagina and erectile tissue

153
Q

Action if sympathetic fibres within pelvic plexus

A

Uterine contraction

Vasoconstriction

154
Q

Pathetic of afferents fibres from

  1. Uterus
  2. Cervix and upper vagina
  3. Lower vagina
A
  1. Back to hypogastric plexus and lumbar splanchnic nerves to lower T and upper L levels of cord
  2. Via pelvic splanchnics
  3. Pelvic splanchnics
155
Q

Position of empty urinary bladder

When full

A

Lesser pelvis

Abdominal cavity

156
Q

Shape of fundus of bladder

Posterior relation

A

Triangular outline

Anterior vaginal wall

157
Q

Peritoneal covering of bladder fundus

Superior surface

A

Parietal peritoneum reflected from anterior abdominal wall

Incomplete covering - thin layer reflexes to form vesico-uterine pouch

158
Q

Direction if bladder apex

Position of bladder neck

A

Towards pubic symphysis

On pelvic floor within fascia surrounding the urethra

159
Q

Reflection of peritoneum and pouches in pelvis

A

Superior surface of bladder –> shallow vesicouterine pouch
From this pouch peritoneum covers uterus and posterior fornix
Uterus to middle part of rectum –> deep rectouterine pouch

160
Q

Bladder ligaments

A

Laterally pelvic fascia thickened and condensed to form lateral true ligaments

161
Q

Lateral ligaments of bladder form two thickened bands called

A

Pubovesical ligaments

162
Q

Medial pubovesical ligament attachment and role

What other structure does it form?

A

Inner aspect pubic bone close to midpoint of PS
Passes down and back to form floor if retro public space
Support bladder neck

163
Q

Apex of bladder is continuous with which structure?

What does this structure represent?

A

Urachus
Median umbilical ligament
Fibrous cord in fold of peritoneum
Closure of upper end of vesico-urethral canal

164
Q

Describe detrusor layers

Which layer gives rise to sphincter vesicae? Where does this lie?

A

3
Outer longitudinal
Middle circular
Inner longitudinal

Middle layer; internal urethral orifice

165
Q

Where dies the trigone lie?
What is it derived from?
How does the mucous membrane in this area differ?

A

Posterior wall of bladder
Fusion of distal ureter ends onto wall
Inferior point from fusion of the two Mesonephric ducts (mesoderm)

More firmly attached to underlying muscle so no folds

166
Q

Which layer do the ureters derive from?

A

Mesoderm

167
Q

Source if efferent parasympathetic supply to bladder

A

Pelvic splanchnic nerves via pelvic plexus

Convey motor fibres to detrusor and inhibitory fibres to sphincter vesicae

168
Q

Nerve supply to urethral sphincter?

What structure does this form?

A

Pudendal nerve

Urogenital diaphragm

169
Q

Length if urethra in female
Name of start and end
Attachment

A

4-6cm
Internal urethral orifice to external orifice in the vestibule immediately anterior to vagina
Walls in contact except when urine passed
Urethra firmly attached to anterior vaginal wall

170
Q

Glands of urethra

Name of largest epithelial fold

A

Numerous small mucous secreting
At distal end several open into para urethral duct
Duct runs down in submucosal tissue, opens on lateral aspect external urethral orifice
Large posterior fold = crest

171
Q

Muscle fibre arrangement in urethra

A

Continuous with bladder smooth muscle
BUT
Inner longitudinal and outer circular (ie no 3rd outer longitudinal)

172
Q

Structure of urethral epithelium

A

Proximally transitional
Distally non-keratinised stratified squamous
Below mucous layer thin layer of erectile tissue and plexus of veins

173
Q

Blood supply to urethra

A

Internal pudendal

Perineal branches

174
Q

Innervation of urethra

A

Autonomic via pelvic plexus

175
Q

Where does urine escape to in case if urethral rupture?

A

Below level of urogenital diaphragm deep to membranous layer of superficial fascia
Both layers are attached to ischiopubic rami and continuous around superficial transverse perineal muscles so cannot pass laterally or posteriorly
Via areolar tissue of mons pubis and anterior abdominal wall

176
Q

Embryonic origin of ureters
Length
Position relative to peritoneum

A

Distal end mesonephric duct
25cm
Behind parietal peritoneum

177
Q

Which muscle does ureter descend along?
Which nerve does it cross in front of?
Which vessels cross in front of it?

A

Psoas major
Genitofemoral
Ovarian

178
Q

Which vessels are posterior to the ureter as it enters the pelvis?
Which structure is the ureter heading towards at this point?
Which structure is immediately anterior?

A

End of common iliac or start of internal iliac
Greater sciatic notch along lateral pelvic wall
Ovary

179
Q

At what level do the uttered turn medially?

Which vessels cross superiorly at this point?

A

Level with ischial spine

Uterine vessels as they enter broad ligament at level if cervix

180
Q

What is the relation of the ureter to the supravaginal cervix?

A

2cm lateral as they pass forward before inclining medially to enter posterior bladder wall related to anterior aspect of vagina

181
Q

Why does one ureter often have a closer relation to the anterior vagina than the other?

A

Uterus often to one side of median plane

182
Q

Describe coats of ureter

A

3
Outer: fibrous, continuous with kidney capsule, merges into bladder wall
Intermediate: inner longitudinal and outer circular muscle layers in upper 2/3 ureter, further outer longitudinal layer in distal 1/3 but inner layer less developed
Inner: thrown into longitudinal folds and covered in transitional epithelium

183
Q

Blood supply of ureter

A

Anastomoses of several arteries
Proximal: renal
Also: ovarian, CIA, superior vesical

184
Q

Nerve supply of ureter

A

Branches of renal, aortic, pre sacral and pelvic autonomic plexuses

185
Q

4 point of perineal diamond
Names of 2 triangles and dividing line
Where do the muscles of these triangles unite?

A

Pubic symphysis
Coccyx
Ischial tuberosities

Arbitrary line between tuberosities divides into triangles
Urogenital
Anal

Perineal body

186
Q

Superficial muscles of urogenital region

A

Bulbospongiosus
Ischiocavernosus (R,L)
Transverse perineal (R,L)

187
Q

Deep muscles of urogenital region

A

Urethral sphincter
Deep transverse perineal

Occupy deep perineal pouch and collectively form urogenital diaphragm

188
Q

Describe the urogenital diaphragm

A

Deep muscles of perineum - urethral sphincter and deep transverse perineal muscles - between 2 layers of fascia (superior fascia of UGD and thicker inferior fascia if UGD also called perineal membrane)

189
Q

Which nerve roots form sacral plexus?

A

Lumbo sacral trunk L4-5

Anterior primary rami S1-4

190
Q

Where does the sacral plexus lie?

A

On piriformis

Behind internal iliac vessels, ureter and gut

191
Q

How do the sciatic plexus nerves exit the greater sciatic foramen?

A

In 2 groups
Upper form sciatic L4-S2,part S3
Lower form pudendal partS2, S3-4

192
Q

Which muscles does the sacral plexus supply within the pelvis?

A

Piriformis S1-2 enters anterior surface

Levator ani S4

193
Q

Where does pudendal nerve lie in relation to internal pudendal artery?
Which foramen does it gain entry to pelvis through?

A

Medial

Lesser sciatic to enter pudendal canal innervating perineum and vuvla

194
Q

What is the space between the two layers of fascia of the urogenital diaphragm called?

A

Deep perineal pouch

Muscles
- deep group urethral sphincter, deep transverse perineal
Urethra
Urethral gland
Vessels an nerves
195
Q

Which structure pierce the perineal membrane?

A

Vagina - outer coat fuses with perineal membrane - transverse perineal ligament
Urethra
Blood vessels
Nerves

196
Q

What is the transverse perineal ligament?

A

As outer coat if vagina fuses with perineal membrane it stretches horizontally across public arch with a thickened apex, this thickened part is the TPL

197
Q

Which ligaments does the deep dorsal vein and dorsal nerve of the clitoris clitoris pass between?

A

Transverse perineal ligament

Arcuate pubic ligament

198
Q

Blood supply of perineum

A

Internal pudendal

Terminal branch of anterior division of internal iliac

199
Q

How does internal pudendal artery exit the pelvis?

Which structure accompanies it medially?

A

Via GSF to enter gluteal region

Pudendal nerve

200
Q

What are the boundaries of the pudendal canal?

A

Fascial compartment related to deep surface of ischial tuberosity and ischiopubic rami
Forms lateral boundary of ischioanal fossa (bounded medially by EAS and inferior fascia of pelvic diaphragm)
Roof and lateral wall - lower obturator externus fascia extending upwards to blend with inferior fascia of PD and down to become sacrotuberous ligament

201
Q

Which artery leaves proximal end of pudendal canal?

A

Inferior rectal

Traverses medially across ischioanal fossa to supply anal canal and skin

202
Q

Where does perineal artery branch from internal pudendal?

What does this artery supply?

A

Near the anterior end of pudendal canal

Branches to skin and muscle both deep and superficial to perineal membrane

203
Q

Branches and supply of perineal artery

A

Posterior labial - labia
Artery to bulb of vestibule - erectile tissue
Deep artery of clitoris - corpus cavernosum
Dorsal artery of clitoris - dorsum, glans, prepuce

204
Q

What does inferior rectal nerve supply?

What is this a branch of?

A

EAS
Lower anal canal and perinatal skin

Pudendal nerve (accompanies inferior rectal artery)

205
Q

Branches if the perineal nerve and supply

A
  1. Posterior labial - usually pass anterior to perineal membrane
  2. Deep branches that supply ishiocavernosus
  3. Dorsal nerve of clitoris deep to perineal membrane
206
Q

Which branches of pudendal nerve supply sensory supply to vagina?

A

Inferior rectal

Posterior labial branches

207
Q

Boundaries of anal triangle

A

Posterior aspect of perineal membrane

Ischial tuberosities and sacrotuberous ligament

208
Q

Relation of ischioanal fosse to anal canal

A

Laterally

209
Q

Anal canal length

A

3-4cm

210
Q

Describe mucosa of upper part of anal canal

A

Lined by mucous membrane thrown into folds - anal columns with valves and sinuses at distal end

211
Q

Relation if anal sphincter muscles to anal canal

A

IAS surrounds upper 75% with white line at lower extremity

EAS surrounds lower part, overlapping IAS and inserting into skin at lower end of canal

212
Q

Describe parts of EAS

A
  1. Deep region - fibres interdigitate with puborectalis and muscles of deep perineal ouch via perineal body
  2. Superficial fibres insert into coccyx and contribute to ani coccygeal ligament (separates anus from coccyx)
  3. Subcutaneous - thin horizontal band around distal canal below IAS, some fibres attach to anococcygeal ligament and perineal body - no bony attachments
213
Q 
Uterus
Type of muscle
Normal and pregnant weight
Location
Number if ligaments
A 
Smooth
40g
800g both hypertrophy and hyperplasia
Between bladder and rectum
4
214
Q

Cervix:

Type of tissue

A

Dense connective

215
Q

Point if reflection off uterovesical peritoneal fold

A

Junction between cervix and uterine body

216
Q

Nature if rectovaginal fold

Boundaries if rectouterine pouch

A

Reflection from posterior fornix of vagina onto surface of rectum forming floor of rectouterine pouch

Anterior: posterior wall if uterine body
Posterior: rectum
Laterally: peritoneal folds from cervix to posterior walls if lesser pelvis

217
Q

Uterosacral ligament boundaries

A

Extend posteriorly from cervix to attach to anterior sacrum

Contain smooth muscle and fibrous tissue

218
Q

Contents if broad ligament

A

Tubes
Round ligament
Ligament of ovary

219
Q

How does ovary attach to broad ligament?

A

Attaches to posterior layer via mesovarium

220
Q

Where does the broad ligament run?

A

Side wall of uterus to lateral wall of pelvis creating septum between anterior pelvis containing bladder and posterior region if rectum

221
Q

Extent of suspensory ligament if ovary

Contents

A

Part of broad ligament from infundibulum of tube and upper pole of ovary to lateral pelvic wall

Ovarian vessels and lymphatic continues over external iliacs as a distinct fold

222
Q

What is the mesometrium?

A

Part of broad ligament extending from pelvic floor upwards to ovary and ligament if ovary

223
Q

Uterine artery is a branch of__?

Position

A

Internal iliac
From origin travels within transverse cervical (cardinal) ligament
Crosses above ureter inclining medially
Passes 1.5cm medially to cervix
Then travels superiorly within substance if broad ligament to anastomose with ovarian artery

224
Q

Name of folds within cervical canal

A

Palmate

225
Q

Nature of transverse cervical ligament

A

Not truly ligamentous
Dense condensation of connective tissue around neurovascular structures from lateral walls pelvis to pelvic viscera
Passes backwards and upwards to root of internal iliacs

226
Q

Role of transverse cervical ligament

A

Supports cervix and upper vagina
Helps to maintain angle between axis of vagina and anteverted uterus
(round ligament may also have this role)

Continuous inferiorly with superior fascia of pelvic diaphragm

227
Q

Cervix as a proportion of uterus

A

Cylindrical lower third

Communicates with body via internal os

228
Q

Changes of cervical mucosa with endometrial cycle

A

Very little

229
Q

Cervical changes in pregnancy

A

Increases in vascularity
Mucous secretion thickens
Dense collagen loosens due to fluid uptake by mucopolysaccharides - allows lower section to shorten as upper expands

230
Q

Extent of vagina

A

Muscular tube between cervix and vestibule, opens onto perineum

231
Q

Which fornix is closely related to the peritoneal cavity?

A

Posterior

Covered in peritoneum

232
Q

Blood supply of uterus

A

Mainly uterine arteries

But rich azygous system with contribution from uterine, vaginal and internal pudendal

233
Q

Lymphatic drainage of uterus

A

Mainly internal iliac nodes

Some communication with superficial inguinal via round ligaments so malignant cells can track this way

234
Q

Length of uterine tube

Name if different parts of tube

A

10cm

Fimbriae - Infundibulum - ampulla - isthmus

235
Q

How are ovaries attached to broad ligament?

A

Attached at posterosuperior aspect by short pedicle of peritoneum, the mesovarium

236
Q

Ovary orientation in nullipatius woman

A

Vertical
Medial and lateral surfaces
Tubal and uterine extremities

237
Q

Location of ovary

A

Ovarian fossa on lateral pelvic wall
Lined by parietal peritoneum, separates ovary on lateral surface from extra peritoneal tissue, obturator vessels and nerves
Bounded by obliterated umbilical artery anteriorly, internal iliac posteriorly, tubal extremity is related to external iliac vein

238
Q

What is the mesosalpinx?

A

Mesentery of Fallopian tube

239
Q

What covers medial surface if ovary?

A

Uterine tube

240
Q

What is the ovarian bursa?

A

Peritoneal recess between medial ovary and mesosalpinx

241
Q

Path of sensory fibres from uterine body and fundus

A

Travel with sympathetics via hypogastric plexus to T11-12

242
Q

Path of sensory fibres from cervix and upper vagina

A

Via pelvic splanchnics to S2,3,4

243
Q

Path of sensory fibres from lower vagina and perineum

A

Via pudenadal nerve to S2,3,4

244
Q

Origin of motor fibres to uterine body and fundus

A

Sympathetic from superior hypogastric plexus

245
Q

Origin of motor fibres to lower segment of uterus and upper vagina

A

Parasympathetic origin via pelvic splanchnics

246
Q

Origin of motor fibres to lower vagina and perineum

A

Somatic via pudendal nerve

247
Q

Position of base of breast

Number of lobules

A

Rib 2-6 overlying investing fascia of pec major

20, each with a lactiferous duct in radial arrangement opening around nipple

248
Q

Breast composition
Non pregnant
Pregnant

A

Fat

Increased glandular tissue

249
Q

Sacrum is made of _ vertebrae

A

5

250
Q

Pudendal nerve roots
Regions traversed by perineal nerve
Branches

A

S2-4
Sacral, Gluteal, pudendal canal, deep perineal space, superficial perineal space
Dorsal nerve of penis/clitoris, perineal nerve, inferior rectal nerve

251
Q

Extent of pudendal canal

A

Begins at posterior edge of ischiorectal fossa

Ends at posterior edge of urogenital diaphragm

252
Q

Borders of deep perineal space

A

Fascial plane between superior and inferior fasciae of UGD

253
Q

Sacrum contains _ foramen

A

4

254
Q

Female urethra length

A

5cm

255
Q

Hip bone is made of _ bones

A

3

256
Q

There are _ tendinous insertions of rectus abdominis

A

3

257
Q

External oblique arises from lower _ ribs

A

8

258
Q

Rectus sheath has _ vessels

A

4

259
Q

Origin of pelvic splanchnic nerves

A

S2-4

260
Q

Innervation of piriformis

A

S1-2

261
Q

Sciatic nerve originates from

A

L4-S3

262
Q

Pudendal nerve originates from

Same as which other nerves

A

S2-4

Pelvic splanchnic

263
Q

Are pelvic nerves autonomic?

A

Yes

264
Q

Does sacral plexus give off pudendal nerve

A

Yes

265
Q

Obturator nerve roots

A

L2-4

266
Q

Lymphatic drainage of ureters

A

Internal iliacs

267
Q

How does obturator nerve exit pelvis?

A

Obturator canal

268
Q

Which vessel supplies pelvic ureters?

A

Superior vesical artery

269
Q

Which structure do ureters cross on entering pelvis

A

Bifurcation of common iliacs

270
Q

Which muscle compresses the vagina?

A

Bulbospongiosus

271
Q

Sympathetic innervation to vagina is from?

A

Lumbar splanchnics

272
Q

Lymphatic drainage of cervix

A

Internal iliacs

273
Q

Which ligaments provide major support for uterus?

A

Cardinal

274
Q

Which wall of vagina is longer?

A

Posterior by 3cm

275
Q

Which muscle constricts lower part of vagina?

A

Levator ani

276
Q

Vaginal length

A

7-10cm

277
Q

Support of lower third of vagina

A

Levator fibres and pubococcygeous (fibres of Luschka)

278
Q

Support of middle third of vagina

A

Fibrous attachment to arcuate line

279
Q

Support of upper third of vagina

A

Cardinal and utero sacral ligaments as endo pelvic fascia is continuous with them

280
Q

Nerve supply to lower 2/3 vagina

A

Mainly somatic

Pudendal nerve to skin and subcutaneous tissue

281
Q

Nerve supply to upper vagina

A

Mainly visceral from inferior hypogastric plexus

282
Q

Location of Bartholin’s glands

A

Vestibule 5 + 7 o’clock position

283
Q

Location of Skenes’s glands

A

Peri urethral

284
Q

Peritoneal covering of rectum

A

Anterior and lateral in upper third
Anterior in middle third
None in lower third

285
Q

Rectal blood supply

A

Superior middle and inferior rectal arteries
Superior pierces muscular wall and continues in submucosa to anastomose with inferior
Middle supplies posterior rectum

286
Q

Shape of obturator foramen in female

A

Triangular

cf ovoid in male

287
Q

T/F iliac blades more vertical in male

A

F

288
Q

Supra public arch angle in male

A

50-60 deg

289
Q

Supra public arch angle in female

A

80-85 deg

290
Q

Which sex has narrower greater sciatic notch

A

Male

291
Q

Peritoneum of Fallopian tube

A

Completely covered except narrow inferior strip - upper part of broad ligament or mesosalpinx

292
Q

Fallopian tube lining

A

Ciliated cells interspersed with secretory (peg) cells

293
Q

Part of Fallopian tube with thickest muscle layer

A

Isthmus

294
Q

Part of Fallopian tube with thinnest muscle layer

A

Infundibulum

295
Q

Relation of round ligament to tube

A

Commences in front and below

296
Q

T/F Ovarian ligament attaches lateral to pelvic wall

A

F
Lies beneath posterior layer of broad ligament
Passes from medial pole of ovary to uterus just below tube entry point

297
Q

Path of ovarian artery

A

Aorta just below renals
Down on anterior surface of psoas to pelvic brim
Crosses in front of ureter
Passes into infundibulopelvic fold of broad ligament

298
Q

How do ovarian vessels enter hilum?

A

Through mesovarium

299
Q

Which structures in female are homologous to gubernaculum testis

A

Ovarian and round ligament together

300
Q

Which structure dies ureter lie in front of at pelvic brim

A

Bifurcation of common iliac

Anatomy (10 decks)

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