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Anatomy reproduction > Pelvis and perineum > Flashcards

Pelvis and perineum Flashcards

1
Q

Bony landmarks creating the boundary of the perineum

A
  1. pubic symphysis
  2. ischial tuberosity
  3. coccyx
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2
Q

triangles of the perineum?
what bony prominences separate them?
name of the fascia between the sides of the pubic arch, below the pubic symphysis

A
  • urogenital and anal triangle
  • ischial tuberosities
  • perineal membrane
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3
Q

Muscle of perineum action:
Superficial and deep transverse perineal muscles

A

support & fix perineal body (pelvic floor) to:
i. support abdominopelvic viscera
ii. resist increased intra-abdominal pressure

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4
Q

external anal sphincter function

A

constricts anal canal during peristalsis, resisting defecation.
supports and fixes perineal body/pelvic floor

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5
Q

external urethral sphincter function

A

compresses urethra to maintain urinary continence

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6
Q

bulbospongiosus in male and female function

A
  • compresses bulb of penis to expel last drops of urine/semen
  • assists in clitoral erection & bulb of vestibule. compresses greater vestibular gland
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7
Q

ischiocavernosus

A

maintains erection of penis or clitoris by compressing outflor veins and pushing blood from root of penis or clitoris into body

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8
Q

perineal and anococcygeal body functions
- damage/rupture leads to..

A

muscle attachment areas in the perineum
- prolapse of pelvic viscera

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9
Q

pelvic diaphragm
- fascia
- structures piercing

A

superficial and deep fascia make it up
urethra and rectum pierces diaphragm

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10
Q

what are the parts of the male urethra?

A

spongy
prostatic
membranous/intermediate

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11
Q

male uretha:
widest part?
narrowest?

A

widest= prostatic. urinary & reproductive tracts merge here. ejaculatory ducts open here
narrowest= membranous/intermediate. contraction of muscle surrounding controls urinary continence

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12
Q

Penis muscles

A

2 (left and right) corpus carvenosa
1/single corpus spongiosum

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13
Q

what is the terminal aspect of the penis called

A

glans penis, covered by the prepuce (foreskin)
- provides transit for the urethra via the external urethral meatus

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14
Q

what is the corpus cavernosa covered by

A

tunica albuginea
extra= buck’s fascia is around everything

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15
Q

action:
corpus spongiosum
corpus cavernosum

A

corpus spongiosum= urethra is transmitted
corpus cavernosum= contains majority of erectile tissue in the penis

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16
Q

sensory innervation of penis?

A

dorsal nerve of penis, a branch of pudendal

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17
Q

location of internal/vesical urethral sphincter?
innervation?
voluntary or involuntary?

A

inferior surface of bladder
involuntary
- sympathetic T11-L2
- parasympathetic S2-S4 pudendal

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18
Q

location of external urethral sphincter?
i. in males
ii. in females
innervation?
voluntary or involuntary?

A

i. neck of urinary bladder/anterior prostatic urethra. forms annular sphincter
ii. skeletal muscle encircling membranous urethra, extends to ischial rami and urethra/vagina
voluntary
deep branch of pudendal S2-S4

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19
Q

contents of the vulva

blood supply
innervation

A
  1. labia majora
  2. labia minora
  3. mons pubis
  4. clitoris
  5. vestibule & bulbs of vestibule (enlosed by LM)
  6. vestibular glands (Bartholin’s)

internal pudendal artery
pudendal nerve

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20
Q

clitoris

A
  • erectile corpora cavernosa tissue. genital tubercle origin embryologically
  • 2 crura, meet in midline to form body. projects downwards to the prepuce and glans lying in the anterior labial commissure
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21
Q

anal triangle

A

area between ischial tuberosities, sacrotuberous ligaments and coccyx.
contains anus
internal and external anal sphincters

  • external sphincter has deep, superficial and subcutaneous parts
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22
Q

ischio-anal (ischio-rectal) fossa

A

allow the anal canal to expand during defaecation

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23
Q

What passes through the lesser sciatic foramen to enter the ischio-anal (Rectal) fossa?

A
  1. nerve to obturator internus
  2. pudendal nerve
  3. internal pudendal artery
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24
Q

structures constituting the birth canal

A

uterus, cervix, vagina

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25
Q

layers of uterus

A

Perimetrium
Myometrium
Endometrium

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26
Q

as pregnancy advances, the uterus physiologically has an upper and lower segment:
what area of the uterine body does the lower segment develop from?

A

the area between the cervix and uterus

isthmus and lower half inch of corpus.

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27
Q

C section= what section is opened and what type of incision is used?

A

lower segment
transverse incision (Pfannenstiel)

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28
Q

pouches?

A

uterovesical pouch
pouch of douglas (rectouterine pouch)

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29
Q

ligaments

A

i. broad ligament
ii. round ligament of uterus
iii. ovarian ligament/ligament of ovary
iv. suspensory ligament of ovary
v. cardinal ligament of the uterus = transverse cervical ligament

uterosacral
inguinal
sacrotuberous
sacrospinous

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30
Q

position of uterus

A

anteverted and anteflexed

opposite is retroverted and retroflexed leading to prolapse of uterus into the vagina if ^ intra-abdo pressure

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31
Q

through which vaginal fornix can you enter the rectouterine pouch?

A

posterior

(anterior and lateral ones are the others). fornixes are created because the vagina surrounds the cervix creating two domes

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32
Q

cervix vs uterus

A

cervix is a fixed structure. uterus is supported, but has the ability to move (& ^ in size during pregnancy)

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33
Q

uterine tubes/fallopian tubes/oviduct divisions

A

infundibulum
ampulla= longest and widest. fertilisation occurs here
isthmus
intramural or uterine part

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34
Q

Blood supply to gonads and genetalia is from which branches?

A

branches of aorta= ovarian (gonadal) and internal iliac

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35
Q

ovarian arteries:
- what vertebral level do they originate from?
- where does it path within and how does it supply the ovaries?
- which vessel does it anastamose with?

A
  • L2
  • it passes within the suspensory ligament and supplies the ovaries via the broad ligament
  • uterine artery
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36
Q

ovarian veins; where do they drain?

A

left= left renal vein
right= IVC

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37
Q

where does the uterine artery and ureter meet?

A

the uterine artery crosses OVER the ureter at the level of ischial sphine, junction of cervix and lateral part of fornix of vagina.
– water under the bridge

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38
Q

ovary lymphatics?

A

para-aortic lymph nodes

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39
Q

fundus and upper uterine body lymph nodes?

A

pre-aortic lymph nodes

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40
Q

most part of uterine body lymph?

A

external iliac LN’s

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41
Q

uterine cervix and upper vagina lymph?

A

internal iliac and sacral LN’s

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42
Q

lower vagina

A

superficial inguinal
(sacral and common iliac LN’s)

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43
Q

breast basic info

A
  • highly modified exocrine glands
  • in superficial fascia of pectoral region
    – deep surface has pectoralis major, minor and serratus anterior
  • 15-25 lobes with tubulo-acinar glands (parenchyma) and stroma (connective tissue)
  • extends vertically from 2nd-6th rib
  • extends horizontally from lateral border of the sternum to the mid-axillary line
  • axillary tail: breast cancer spread
44
Q

breast blood supply:

A

branches of subclavian and axillary arteries
* lateral thoracic
* lateral mammary branches
* internal thoracic

thoracoacromial

45
Q

breast lymphatic drainage

A
  1. Axillary
    - apical
    - lateral
    - central
    - posterior
    - pectoral
  2. Parasternal
  3. internal mammary/thoracic

Posterior intercostal
subclavian/supraclavicular

46
Q

first group of lymph nodes draining lateral quadrant of breast tissue?

A

*** axillary?

47
Q

microscopic anatomy

A

puberty, pregnancy, lactation

48
Q

uterus histology

A

phases:
late proliferative
secretory

49
Q

muscular layers of the uterus histologically

A

serosa (adventitia)
muscularis mucosa (outer longitudinal layer and inner circular)
mucosa

50
Q

ovary microscope follicles (histological development)

A

primordial, primary, secondary, graffian
different stages of oogenesis

  • corpus luteum, albicans
51
Q

what does the placenta develop from?

identify foetal vs maternal side

A

the trophoblast following implantation of the blastocyst into the uterine endometrium

52
Q

functions of the placenta

A
  1. gaseous exchange
  2. metabolic transfer
  3. hormone secretion
  4. fetal protection
53
Q

what stage of labour does the placenta separate from the uterine wall?

A

3rd stage

54
Q

umbilical cord histology; 2 arteries and 1 vein
W?

A

W= wharton’s jelly

55
Q

action of umbilical vessels?

A

arteries: carry deoxygenated blood from the fetal circulation to placenta
veins: carry oxygenated blood from placenta to fetus. persists as ligamentum teres in adults

56
Q

male reproductive organs;

A

testis
ductus deferens
seminal glands
prostate
epididymis
bulbourethral glands

57
Q

what do the testis pass through during development?

A

inguinal canal

deep and superficial= internal and external inguinal rings

58
Q

layers of spermatic cord:

A

external spermatic fascia
cremasteric fascia
internal spermatic fascia

59
Q

spermatic cord contents

A

vas deferens
cremaster muscle
lymph vessels- draining into para-aortic LN’s in lumbar region
pampiniform plexus (testicular vein)
testicular artery, cremaster artery, artery to vas deferens
nerves- genital branch of genitofemoral nerve supplying cremaster muscle

60
Q

tough outer fibrous layer of the testis?

A

tunica albuginea

61
Q

tunica vaginalis

A

visceral and parietal with viscous fluid between

62
Q

at what vertebral level do the testicular arteries arise from the aorta?

A

L2

63
Q

how do the testicular arteries travel?
what structures do they cross?

A

retroperitoneal
i. genitofemoral nerve
ii. ureter

64
Q

venous anastomosing drainage of the testes? function

where do the veins drain?

A

pampiniform plexus= temp regulation

right testicular vein= IVC
left= left renal vein

65
Q

lymphatic drainage of the testis?

A

lumbar and para-aortic lymph nodes

66
Q

lymphatics of prostate

A

internal iliac and sacral LN’s

67
Q

lymphatics of seminal vesicles

A

internal and external iliac LNs

68
Q

lymphatics of scrotum

A

superficial inguinal LNs (medially)

69
Q

lymphatics of penis

A

superficial inguinal
(internal iliac, lateral sacral and hypogastric)

70
Q

epididymis role

A

stores sperm that is produced. attached to the body of the penis

71
Q

vas deferens

A

muscular tube arising from tail of epididymis
- traverses the inguinal canal
- enters the pelvis by crossing over the external iliac vessels
- crosses over ureter before joining the duct of seminal gland to form the ejaculatory duct

72
Q

seminal gland location and function

A

either side of the posterior surface of the bladder
produces a thick alkaline fluid that mixes with sperm as they pass into ejaculatory ducts and urethra.

73
Q

prostate gland location and function

A

fused to the inferior neck of the bladder surrounding the prostatic urethra
prostatic fluid produced; thin and milky
- contains clotting enzymes that coagulate semen after ejaculation

74
Q

prostate venous drainage

A

prostatic venous plexus. may lead to spread of bone cancer (metastases)
communicates with the internal vertebral venous plexus

  • prostate is a vascular organ= risk of bleeding with operations here
75
Q

bulbourethral glands location and function

A

cowper’s glands
small, paired structures
* located in urogenital diaphragm
- empties into the penile/spongy urethra

  • secretes clear, colourless mucus-like product prior to ejaculation
    it neutralises the acid environment of urethra to protect sperm and adds lubrication
76
Q

venous drainage of pelvis

A

interplay between portal and systemic circulations
clinical significance in some pathologies e.g. liver cirrhosis, pelvic cancers
venous plexuses e.g. prostatic

77
Q

which part of the rectum drains into portal circulation

A

superior rectal vein

78
Q

which part of the rectum drains into the systemic circulation

A

middle and inferior rectal veins

79
Q

significance of rectal venous drainage?

A
  1. pelvic congestion syndrome
  2. site of portocaval anastomoses (anastomoses between portal and systemic veins located in anal canal wall)
80
Q

haemorrhoids and liver cirrhosis relation?

A

liver disease= blood flow block to liver.. backup of drainage
- veins become dilated and cause haemorrhoids

81
Q

somatic nerve supply to reproductive organs?

A

ilioinguinal
genitofemoral
pudendal

82
Q

ilioinguinal nerve

A

L1
enters at superficial inguinal ring
supplies skin at root of the penis in male and labia in females

83
Q

genitofemoral nerve

A

L1-L2
enters the deep inguinal ring
supplies scrotal skin and cremaster muscles in male (motor innervation)

*testicular torsion= cremasteric muscle spasm

84
Q

pudendal nerve

A

S2-S4
arises from sacral plexus, following course of pudendal artery
innervate sin and muscles of perineum

  • nerve block during labour; bony landmarks used= ischial spines
85
Q

autonomic nerve supply

A

originates from pelvic plexus or inferior hypogastric

86
Q

sympathetic fibres

A

T10-L2 via hypogastric nerve and terminal aspect of sympathetic trunk
hitchhike on arterial supply
all internal pelvic organs

87
Q

parasympathetic fibres

A

pelvic splanchnic nerves S2-S4
all internal pelvic organs and erectile tissues in both males and females

88
Q

external iliac LN’s drain:

A

from inguinal LN’s
superior parts of anterior pelvic organs

(distal vagina, vulva & gluteal region)

89
Q

internal iliac LN’s drain:

A

inferior pelvic organs, gluteal region and deep perineum

90
Q

sacral LN’s drain:

A

postero-inferior pelvic organs

91
Q

common iliac LN’s drain:

A

external, internal and sacral LN’s

92
Q

pelvic arteries blood distribution

A

to most of the pelvic organs, perineum and gluteal region except the testis, ovary and upper part of the rectum

93
Q

internal iliac branches:

A
  1. superior and inferior vesicle
    - bladder, seminal gland and prostate in males
  2. uterine artery
    - round lig of uterus, uterus, uterine tube, vagina, pelvic part of ureter
  3. middle and inferior rectal
    - lower 1/3 of rectum, anal skin, musculature and skin of buttock
  4. internal pudendal
    - main artery to perineum
  5. obturator
    - pelvic muscles, nutrient artery to ilium and head of femur
94
Q

abdominal aorta

A

gonadal (testicular or ovarian)
- testicles or ovaries

95
Q

inferior mesenteric a.

A

superior retal artery
- upper 2/3 of rectum, sigmoid colon

96
Q

uterine artery

A

vagina
- vagina and branches to inferior (fundus)of urinary bladder

97
Q

which muscles make up the majority of the pelvic floor?
- other muscles

innervation?
function

A

coccygeus
levator ani (pubococcygeus, iliococcygeus, puborectalis)
- piriformis and obturator internus

pudendal nerve

98
Q

perineal body and anococcygeal body

A
99
Q

antero-inferior wall of pelvic cavity formed from?

A

bodies and rami of the pubic bones and the pubic symphysis

100
Q

posterior wall of pelvis:
muscle?
nerve network?

A

piriformis
sacral plexus

101
Q

male vs female
1. pelvic inlet
2. obturator foramen
3. acetabulum

A
  1. male- heart shaped
    female- oval/rounded
  2. round
    oval
  3. large
    small
102
Q

narrowest diameter of pelvic inlet and outlet?

A
103
Q

pelvic outlet boundaries

A

inferior margin of pubic symphysis
inferior rami of pubis
tip of coccyx
sacrotuberous ligament

104
Q

what type of joint is the SI joint?

A

synovial anterior
syndesmosis posterior

105
Q

what type of joint is the pubic symphysis?

A

secondary cartilaginous joint/symphysis

106
Q

bony landmarks making up superior pelvic aperture (pelvic inlet/brim)

A

sacral promontory
ala of sacrum
pubic tubercle (outside)
pubic crest
arcuate line of ilium
pubic symphysis

Anatomy reproduction (1 decks)

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