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Moores Blue Boxes > Peritoneum > Flashcards

Peritoneum Flashcards

1
Q

What are the most common male pelvis types

A

Android and anthropoid

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2
Q

What are the most common female pelvis types (white women)

A

Android and gynecoid

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3
Q

Most common pelvis types n black females

A

Gynecoid

Anthropoid

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4
Q

What pelvic type is uncommon in both sexes

A

Platypeloid

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5
Q

What is the normal female type of pelvis

A

Gynecoid

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6
Q

Describe the gynecoid pelvis

A

Pelvic inlet has a rounded oval shape and a wide transverse diameter

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7
Q

What sort of problem would a woman with a platypelloid or android pelvis encounter (masculine or funnel shaped)

A

Hazard to vaginal delivery of a fetus

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8
Q

In forensics, how is pelvis used

A

Determine sex

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9
Q

What are sex determining characteristics of pelvis

A

Pelvic girdle!

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10
Q

Why is the size of the lesser pelvis importan

A

It is the bony canal that the fetus passes through

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11
Q

How do you determine the capacity of the female pelvis for childbearing

A

Diameters of lesser pelvis are noted radiographically or manually examined

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12
Q

What is the true(obstetrical) conjugate

A

Minimum anteroposterior diameter of the lesser pelvis

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13
Q

How measure the true conjugate

A

From middle of sacral promontory to the posterosuperior margin (closest point) of the pubic symphysis

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14
Q

What does the true conjugate represent

A

Narrowest fixed distance through which baby head will pass

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15
Q

Why cant the true conjugate be measured directly during pelvic exam

A

Presence of the bladder

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16
Q

What is the diagonal conjugate

A

Sacral promontory with the tip of the middle finger to the inferior margin of the pubic symphysis on the examining hand —-withdraw hand and measure

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17
Q

Why is the diagonal conjugate helpful

A

Can be used to estimate true conjugate

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18
Q

How big should the true conjugate be

A

11cm or greater

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19
Q

Anatomical conjugate

A

Top of pubic symphysis to sacral promontory

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20
Q

True obstetric conjugate

A

Middle of pubic symphysis to sacral promontory

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21
Q

Dianagnol conjugate

A

Bottom of pubic symphysis to sacral promontory

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22
Q

Typical size of diagonal conjugate

A

11.5 cm

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23
Q

What is the narrowest part of the pelvic canal

A

The interspinous distance

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24
Q

What is the interspinous distance

A

The ischial spines extend toward each other

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25
Q

What is the pelvic canal

A

Passageway through the pelvic inlet, lesser pelvis, and pelvic outlet

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26
Q

Is the interspinous fixed

A

No it relaxes in late pregnancy

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27
Q

During a pelvic examination, if the ischial tuberosities are far enough apart to permit __ fingers to enter the vagina side by side

A

3

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28
Q

The __ angle is considered sufficiently wide to permit passage of an average fetal head at full term

A

Subpubic

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29
Q

What sort of injury causes fracture of pubic rami

A

Anteroposterior compression of the pelvis during crush accidents (when a heavy object fails on the pelvis)

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30
Q

What happens when the pelvis compressed laterally

A

The acetabula and ilia aresqueezed toward each other and may be broken

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31
Q

Fractures of the bony pelvic ring are almost always ___ fractures or a fracture combined with a joint ____

A

Multiple

Dislocation

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32
Q

Some pelvic fractures result from the tearing away of bone by the strong ligaments of the ___ joint

A

Sacro iliac joint

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33
Q

How do you get pelvic fractures

A

Directly

Indirectly through leg

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34
Q

What are the weak areas of pelvis where fractures often occur

A

Pubic rami
Acetabula (or around)
Sacroiliac joints
Alae of the ilium

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35
Q

What may pelvic fractures injure

A

Soft tissues, blood vessels, nerves,and organs

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36
Q

Fractures in pubo-obturator area common. What complication is common

A

Relationship with urinary bladder and urethra which may be ruptured or torn

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37
Q

What may falls on buttox from a high ladder cause

A

Femur through the acetabulum into the pelvic cavity injuring pelvic viscera, nerves and vessels.

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38
Q

In persons younger than 17 what a fracture in the acetabulum like

A

Fracture through triradiate cartilage into its three developmental parts

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39
Q

The larger cavity of the interpubic disc in females __ in size during pregnancy

A

Increases

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40
Q

What does an increase in interpubic disc cause

A

Increases the circumference of the lesser pelvis and contributes to increased flexibility of the pubic symphysis

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41
Q

What causes the pelvic ligaments to relax during the latter half of pregnancy , allowing increased movement of the pelvic joints

A

Relaxin

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42
Q

Relaxin of what joints allies 10-15% increase in diameter facilitates passage of the fetus

A

Sacroiliac joints and pubic symphysis

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43
Q

How does relaxin effect the movement of the coccyx

A

Allows it to more posteriorly

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44
Q

What is the one pelvic diameter that remains unaffected by relaxin

A

True (obstetrical) diameter between the sacral promontory and the posterosuperior aspect of the pubic sympathy sis

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45
Q

Relaxation of the sacro-iliac ligaments causes the interlocking mechanism of the ___ joint to become less effective, permitting greater rotation of the pelvis and contributing to the __ posture assumed during pregnancy

A

Sacral iliac

Lordotic

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46
Q

Why may lat pregnancy be associated with possibility of greater joint dislocation (throughout body)

A

Relaxation o ligaments not limited to pelvis

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47
Q

Spondylolysis

A

Part of vertebral arch to be separated from its body

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48
Q

Spondylolysis of L5

A

From separating of the vertebral body from the part of its vertebral arch bearing the inferior articular process.

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49
Q

The inferior process of L5 normally interlock with the articular process of the ___

A

Sacrum

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50
Q

What happens when sponylolyisis is bilateral

A

The body of L5 vertebrae may slide anteriorly not he sacrum (spondylolisthersis) so that it overlaps the sacral promontory

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51
Q

What happen with intrusion of L5 body into the pelvic inlet

A

Reduces AP diameter of the pelvic inlet which may interfere with parturition, it may also compress spinal nerves, causing low back or lower limb pain

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52
Q

How do obstetricians test for spondylolisthesis

A

Running fingers along the lumbar spinous process. An abnormally prominent L5 indicates that the anterior part of L5 vertenra and the vertebral column superior to it may have moved anteriorly relative to the sacrum and the vertebral arch of L5

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53
Q

How do we confirm sondylolisthesis

A

Medical images such as sagittal MRI are taken to confirm the diagnosis and to measure the AP diameter pelvic inlet

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54
Q

What does the pelvic floor do during childbirth? What does the cervix and uterus do during childbirth?

A

Supports the fetal head

Dilate to permit delivery of the fetus

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55
Q

What may be injured during childbirth

A

Perineum, levator ani, and ligaments of the pelvic fascia

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56
Q

What muscles are torn most often during childbirth

A

Pubococcygeus and puborectalis, the main and most medial parts of thee levator ani

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57
Q

Why are the pubococcygeus and puborectalis important

A

Encircle and support the urethra vagina, and anal canal

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58
Q

What happens when we weaken the levator ani and pelvic fascia from stretching or tearing during childbirth

A

Decrease support of the vagina, bladder, uterus or rectum of alter the position fo the neck of the bladder or urethra which may cause URINARY STRESS INCONTINENCE

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59
Q

Characterization of urinary stress incontinence

A

Dribbling of urine when intra-abdominal pressure is raised during coughing and lifting which can lead to prolapse of one or mor pelvic organs

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60
Q

Tearing of the puborectalis, produces what

A

Anorectal angle and increases the angle to maintain fecal continence is likely to result in various degrees of fecal incontinence

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61
Q

The ureter is crossed by the ___ ___ near the lateral part of the fornix of the vagina . Why is this clinically important

A

Uterine artery
The artery actually winds 50% or more of the way around the ureter, passing at least both superior and anterior to the ureter
URETER IS IN DANGER ONF BEING INADVERTENTLY CLAMPED, LIGATED, or TRANSECTED during a hystectomy when the uterine artery s ligated and severed to remove the uterus

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62
Q

What is the approximate point where the ureter and uterine artery cross

A

2 cm superior to the ischial spine

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63
Q

Why are ureters in danger during oophorectomy (excision of ovary)

A

Vulnerable to injury when ovarian vessels are ligated bc they are close to each other as they cross the pelvic brim

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64
Q

Occasionally the internal iliac artery becomes __ due to atherosclerotic cholesterol deposit

A

Senotic

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65
Q

Why does ligation of the iliac artery NOT reduce blood flow but DOES reduce bp

A

Numerous anastomoses between the artery’s branches and adjacent arteries

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66
Q

Example of collateral pathways to internal iliac artery

A

Lumbar and iliolumbar

Median sacral and lateral sacral

Superior rectal and middle rectal

Inferior gluteal and profunda femoris artery

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67
Q

Blood flow in the internal iliac artery is maintained, although it may be __ int he anastomotic branch

A

Reversed

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68
Q

The collateral pathways may maintain the blood supply to the pelvic viscera, gluteal region and genital organ

A

Woohoo

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69
Q

During childbirth, the fetal head may compress the nerves of the mothers ___ ___,

A

Sacral plexus

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70
Q

Symptoms of sacral plexus compression from childbirth

A

Pain in lower limbs

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71
Q

The ___ nerve is vulnerable to injury during surgery

A

Obturator

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72
Q

Injury to obturator nerve

A

Painful spasms oft he adductor muscles of the thigh and sensory deficits int he medial thigh region

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73
Q

Injury to the nerve to the levator ani, includingg its branches tot he pubococcygeus and/or puborectalis, due to stretching of the nerve during vaginal birth causes what

A

Loss of support of the pelvic viscera and urinary or fecal incontinence similar to that resulting from tearing of the muscle

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74
Q

Why may ureters be injured during abdominal retroperitoneal, pelvic, or gynecological operationsas a result of what

A

Inadvertently interrupting their blood supply

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75
Q

How do we prevent inadvertent injury to ureters

A

Identification during their full course

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76
Q

The longitudinal anastomoses between arterial branches to the ureter ares usually adequate to maintain the blood supply along the length or the ureter, but occasionally

A

They are not.

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77
Q

Traction on the ureter during surgery

A

May lead to delayed rupture of the ureter.

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78
Q

Delayed rupture of the ureter

A

Urethral segment becomes gangrenous and leaks or ruptures 7-10 days after surgery

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79
Q

It is useful to realize that although the blood supply to the abdomen all segment of the ureter approaches from a __ direction, the pelvic segment approaches from a ___ direction. The ureters should be retracted accordingly

A

Medial

Lateral

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80
Q

What happens if ureters are obstructed

A

As expansive muscular tubes, they dilate

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81
Q

Common cause or ureteric obstruction

A

Ureteric calculus

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82
Q

Large calculus cause what

A

Severe pain. Loud to groin. (From lateral abdominal to inguinal regions)

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83
Q

What is the pain from calculus described as

A

Colicky

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84
Q

Why get colicky pains with calculus

A

Hyperperistsalsis in the ureter, superior to the level of obstruction

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85
Q

Where do ureteric obstruction from calculus most commonly occur

A
  1. Junction of the ureters and renal pelvic
  2. where they cross the external iliac artery and the pelvic brim
  3. During their passage through the wall of the urinary bladder
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86
Q

How can be confirm a calculi

A

Radiograph, an IV urogram or CT scan

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87
Q

How can we remove ureteric calculi

A

Open surgery, endoscopy, or lithotripsy.

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88
Q

Lithotripsy

A

Uses shock waves to break up a stone into small fragments that are passed int he urging

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89
Q

How can you get loss of bladder support, leading to a collapsed bladder onto the anterior vaginal wall

A

Damage to pelvic floor during childbirth, lesion of the nerves supplying them , or rupture of the fascial support of the vagina can result in a loss of bladder support

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90
Q

When the intra-abdominal pressure increases ,the base of the bladder and upper urethra is pushed against the what

A

Anterior wall of the vagina, which lacking support will turn bulges into the vaginal lumen and may protrude through the vaginal orifice into the vestibule-cystocele

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91
Q

Cystocele

A

Herniation of the urinary bladder

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92
Q

Even in the absence of a cystocele, the weakened support to the vagina or pelvic floor may result in a lack of support of the __, which runs in close proximity to what

A

Urethra

The anterior abdominal wall

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93
Q

Lack of support may alter the normal placement, direction, or angle of the urethra . What is this called

A

Urethrocele

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94
Q

Issue with urethrocele

A

Diminishing the usual passive compression of the urethra that helps maintain urinary continence during temporary increases in intraabdominal pressure (cough, sneeze) causing urodynamic stress incontinence

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95
Q

Rodurodynamic stress incontinence treatment

A

Pelvic floor muscles exercises, pessaries, pharmacotherapy

Surgery-retethering of the vagina and/or theplacent of support directly to the urethra to resort its direction and enable passive compression

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96
Q

Where does the superior surface of the empty bladder lie

A

Level of superior margin of the pubic symphysis

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97
Q

As the bladder fulls , it extends superiorly abover the symphysis into the loose are areolar tissue between the parietal peritoneum and anterior abdominal wall

A

Ok

Then it lies adjacent to the walll without the intervention of the peritoneum

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98
Q

Suprapubic cystotomy

A

Distended bladder may be punctured

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99
Q

How can we access the distended bladder surgically

A

Superior to the pubic symphysis for the introduction of the indwelling catheters or instruments without transversing the peritoneum and entering the peritoneal cavity.

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100
Q

What else can be removed through a suprapubic extraperitoneal incision

A

Urinary calculi, foreign bodies and small tumors

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101
Q

Why does a distended bladder rupture with injuries to the inferior part of the anterior abdominal wall or by fractures of the pelvi.

A

Superior position of the distended bladder

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102
Q

What happens if bladder ruptures

A

Escape of urine extraperitoneally or intraperitoneally

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103
Q

Rupture of the superior part othe the bladder results in what

A

Tears the peritoneum, resulting in extravasation of using into the peritoneal cavity

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104
Q

Posterior rupture of the bladder

A

Passage of urine extraperitoneally into the perineum

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105
Q

Cystoscope

A

Examines bladder

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106
Q

How d we do transurethral resection of a tumor with a cytoscope

A

Passed into bladder through the urethra
Then use high frequency electrical current, the tumor is removed in small fragments, which are washed from the bladder with after

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107
Q

Female urethra

A

Distensible bc it contains considerable elastic tissue, as well as smooth muscle.

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108
Q

Why are catheters/cytoscope easier in females

A

Urethra can be easily dilated without injury

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109
Q

Why are infections or the urethra and bladder more common in females

A

It is short, more distendible and is open to the exterior through the vestibule of the vagina

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110
Q

What may be palpated through fetal examination

A

Structures related to antero-inferior part of the rectum. (Prostate and seminal glands in males and cervix in females
Pelvic surfaces of sacrum and coccyx, ischial spines and tuberosities (both sexes)

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111
Q

What pathologies can you feel in a rectal exam

A

Enlarged internal iliac lymph nodes pathological thickening of the ureters, swellings in the ischio-analabscesses and abnormal contents int he rectovesical pouch int he male or recto-uterine pouch in the female
OR tenderness of the inflamed appendix if it descended into the lesser pelvis

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112
Q

Protoscope

A

Examines and biopsies the internal aspect of the rectum

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113
Q

Sigmoidoscope

A

Curvatures of the rectum and its acute flexion at the rectosigmoid junction have to be kept in mind so the patient does not undergo unnecessary discomfort

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114
Q

Useful landmark for sigmoidoscope

A

Transverse rectal folds, but may also impede passageway!

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115
Q

When respecting the rectum in males, the plane of the rectovesical septum is located so that the prostate and urethra can be separated from the rectum. Why

A

These organs are not damaged during surgery

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116
Q

Deferenectomy/vasectomy

A

Part of ductus deferens is ligated and/or excised through an incision in the superior part of the scrotum so that ejaculated fluid fromt he seminal glands, prostate, and bulbourethral glands contains no sperm

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117
Q

If u have a vasectomy, what happens to the sperms

A

Degenerate in the epididymis and the proximal part of the ductus deferens

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118
Q

Reversal of a deferentectomy

A

Ok 7 years after. Ends of sectioned ductus deferentes are reattached under an operating microscope

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119
Q

Abscess in seminal gland

A

Collection fo pic that may rupture

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120
Q

Where does pus from a a ruptures abscess in seminal gland go

A

Peritoneal cavity

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121
Q

How can you palpate seminal glands

A

Rectal exam espicially if enlarged or full and bladder is distended

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122
Q

Treatment for gonococci

A

Massage seminal glands through rectal exam to release their secretion for examination

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123
Q

BHP

A

Common Middle Age effecting every male whol lives long enough

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124
Q

What does an enlarged prostate cause

A

Projects into the urinary bladder and impedes urination by distorting the prostatic urethra

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125
Q

Which prostatic lobule enlarges most

A

Middle

It obstructs the internal urethral orifice

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126
Q

In BHP the most a persons trains to pee, the more what

A

The valve like prostatic mass obstructs the urethra

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127
Q

BHP is a common cause of urethral obstruction, leading to —— , ___, and ___

A

Nocturnal, dysuria, urgency

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128
Q

BHP also increases risk of bladder __ and kidney ___

A

Infection

Damage

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129
Q

How examine prostate

A

Through rectum for enlargement and tumors

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130
Q

What does palpability of prostate depend on

A

Fullness of bladder. Full bladder offers mores resistance holding the prostate in place making it more palpable

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131
Q

What does a malignant prostate feel like

A

Hard and irregular

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132
Q

In metastic prostatic cancer, where does it metasticize

A

Initially to the internal iliac and sacral lymph nodes and later to distant nodes

Also via venous routes (by way of the internal vertebral venous plexus to the vertebrae and brain

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133
Q

Bc of the close relationship of the prostate to the prostatic urethra, obstructions may be relieved ___

A

Endoscopically

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134
Q

Transurethral resection of the prostate TURP

A

Through urethra into prostatic urethraand allor part of prostate is removed.

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135
Q

Radical prostactomy

A

All is removed with seminal glands, ejactulatory ducts, and terminal parts of the deferent ducts

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136
Q

TURP

A

Preserve nerves and bv associated with the capsule of the prostate that pass to and from the penis, increasing the possibility for patient to retain sexual function after surgery as well as restoring normal urinary control

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137
Q

How does the female genital tract communicate with the peritoneal cavity . What is the clinical importance

A

Through the Ostia of the uterine tubes. Infections of the vagina, uterus, and tubes may result in peritonitis

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138
Q

Salpingitis

A

Inflammation of a tube may result from infections that spread from the peritoneal cavity

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139
Q

Major cause of infertility in women

A

Blockage of the uterine tubes, often the result of salpingitis

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140
Q

How see potency of the uterine tubes

A

Radiographically procedure involving injection of a water soluble radioopaque material or CO2 gas into he uterus and tubes through the external os of the uterus (hysterosalpingography)

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141
Q

How see indication that tubes are patent on radiograph

A

Accumulation of radioopaque fluid or the appearance of gas bubbles in the pararectal fossa (pouch) region of the peritoneal cavity

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142
Q

Hysteroscopy to determine potency of uterine tubes

A

Examination of the interior of the tubes using a narrow endoscopic instrument (hysteroscope), which is introduced through the vagina and uterus

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143
Q

Tubal sterilization

A

Permanent , surgical method of birth control. Oocytes released from the ovaries that enter the tubes of these patients degenerate and are soon absorbed .
Can be done laparoscopically or abdominal approach

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144
Q

How do open abdominal tubal sterilization

A

Through a short suprapubic incision made at the pubic hairline and involves removal of a segment or all of the uterine tube.

145
Q

How do laparoscopic tubal sterilization

A

Done with a fiber optic laparoscope inserted through a small incision usually near the umbilicus. Then tubal continuity is interrupted by applying cautery, rings, or clips

146
Q

Hysteroscopic sterilization

A

Nonsurgical
Placement of nickel titanium alloy inserts into the openings of each uterine tube. Scar tissue forms around the implants, blocking the uterine tubes. Takes 3 months

147
Q

Do u need contraception right after hysteroscopic sterilization

A

Yea may take over 3 months

148
Q

How can you tell that hysteroscopic sterilization works

A

Hysterosalpingography done 3 months after to ensure uterine tubes are blocked

149
Q

Tubal pregnancy

A

Most common ectopic gestation

1/250 pregnancies

150
Q

If ectopic pregnancy not caught what may happen

A

Rupture of the uterine tube and severe hemorrhage into the abdominaopelvic cavity during the first 8 weeks o gestation.

151
Q

What happens when tubal pregnancy ruptures

A

Death embryo and threat to mothers life

152
Q

Pyosalpinx

A

Collection of pus may develop in uterine tube and may occlude by adhesions

153
Q

What happens to morula if have pyosalpinx

A

May not be able to pass along the tube to the uterus, although sperms have obviously done so

154
Q

What happens if a blastocyst forms and there is pyosalpinx

A

It may implant in the mucosa of the uterine tube producing an ectopic tubal pregnancy.

155
Q

Most common site of tubal pregnancy

A

Ampulla

156
Q

Increased risk of what with faulty tubal sterilization

A

Ectopic tubal pregnancy

157
Q

On the right side, the __ often lies close to the ovary and uterine tube

A

Appendix

158
Q

What may a ruptured tubal pregnancy and resulting peritonitis be misdiagnosed as

A

Appendicitis

159
Q

Where is pain referred to ruptured right tubal pregnancy and appendicitis

A

Right lower quadrant of abdomen

160
Q

Occasionally the mesosalpinx between the uterine tube and the ovary contains ___ ___

A

Embryonic remnants

161
Q

Epoophoron

A

Forms from remnants of. The mesonephric tubules of the mesonephric, the transitory embryonic kidney

162
Q

Persistent duct of the epoophoron (duct or Gardner)

A

Remnant of the mesonephric duct that forms the ductus deferens and ejaculatory duct in the male

163
Q

Where does the duct of the epoophoron (duct or garter) lie

A

Between layers of the broad ligament along each side of the uterus and/or vagina

164
Q

Vesicular appendage

A

Sometimes attached to the infundibulum or the uterine tube. It is the remains of the cranial end of the mesonephric duct that forms the ductus epididymis.

165
Q

Vestigial structures may form __

A

Cysts

166
Q

Big ornate uterus

A

Incomplete fusion of the embryonic paramesonephric ducts, from which the uterus is formed, results in a variety of congenital anomalies …like DUPLICATION IN THE FORM OF A BICORNATE UT

167
Q

Unicornate uterus

A

Receiving a uterine duct only from the right or left

168
Q

Uterus didelphys

A

Completely doubled uterus

169
Q

Normal position of the uterus

A

Anteverted and anteflexed, so that the body of the uterus rests upon the empty bladder, one of several means by which passive support for the uterus may be provided

170
Q

The size and disposition of the uterus may be examined by ___ ___

A

Bimanual palpating

171
Q

How do bimanual palpation

A

Two gloved fingers of examiners dominant hand are passes superiorly in the vagina, while the other hand is pressed inferno posteriorly not he pubic region of the anterior abdominal wall

172
Q

Softening of the uterine isthmus (hears sign)

A

Cervix feels as though separated from body ofthe uterus..early sign of pregnancy

173
Q

Rectovaginal exam

A

Uterus if retroverted and retroflezed one finger in vagina and one in butt hole

174
Q

Position of uterus in bimanual palpation

A

Anterverted and anteflexed

175
Q

Uterus birth

A

Body to cervical ration 2:1 due to preparation influence of maternal hormones

176
Q

After birth uterus and child

A

1:1 with the cervix being of greater diameter

177
Q

During infancy the uterus is mainly an __ organ

A

Abdominal

178
Q

Puberty uterus

A

2:1

179
Q

Uterus in postpubertal, premenopausal, nonpregnant woman

A

Body is pear shaped, thick walled superior two thirds of the uterus lies within the pelvic cavity

Monthly changes in size, weight, and density in relation to normal menstruated cycle

180
Q

Uterus in pregnancy

A

Gravis-expands greatly to accommodate the fetus, becoming larger and increasingly thin walled

181
Q

End of pregnancy

A

Fetus drops as the head becomes engaged into e lesser pelvis and uterus becomes nearly membranous, with the fundus dropping below its highest level at which time it extends superiorly to the costal margin, occupying most of the abdominopellvic cavity

182
Q

Uterus immediately after delivery

A

Large uterus becomes thick walled and edematous but its size reduced rapidly

183
Q

Multiparous nongravid uterus

A

Large and nodular body and usually extends into the lower abdominal cavity, often causing a slight protrusion of the inferior abdominal wall in lean women

184
Q

Uterus menopause

A

Decreases in size

Involuted and regresses to a markedly smaller size, once again 1:1

185
Q

Cervical cytology

A

Allows detection and treatment of premalignant cervical conditions

186
Q

In Pap test a vaginal speculum is able to go into __ os of the uterus

A

External to gather supravaginal cervical mucosa

187
Q

Who should get cervical cancer screening

A

30-65 get cytology and testing for hpv every 5 years

188
Q

What is the leading cause of cervical cancer in women

A

HPV

189
Q

Why no get HPV test 21-29

A

High prevelance of HPV in this population. Just get cytology every three years

190
Q

Cervical cancer spread to bladder. How

A

No peritoneum between anterior cervix and the base of bladder

191
Q

What nodes does cervical cancer spread to

A

Internal iliac or sacral

192
Q

Hematogenous spread of cervical cancer

A

Iliac veins or via internal vertebral venous plexus

193
Q

Hystectomy

A

Uterine disease (fibroids, endometriosis, or uterine or cervical cancer)

194
Q

How may the uterus be approached and removed

A

Anterior abdominal wall or through vagina

Transabdominal approach or trasvaginal approach

195
Q

Radical hystectomy

A

Removal of the ovaries in addition to uterus

196
Q

Subtotal hysterectomy

A

Uterus divided at the isthmus

197
Q

Cervical or total hysterectomy

A

Vaginal for ice are incised, encircling the cervic to separate the uterus from the vagina. Superior end of the vagina is then closed by suture. Ligation of the uterine artery is performed distal to the vaginal artery and the vaginal branches to enable maximal blood flow to the superior end of the vagina to facilitate healing

198
Q

The vagina can be markedly __, particularly in the region of the posterior part of the fornix

A

Distended

199
Q

Distension of the posterior part of the fornix allows what

A

Palpating of the sacral promontory during pelvic exam

200
Q

The vagina is especially distended by the fetus during parturition, particularly in the _ direction when the fetus’s shoulders are distended

A

AP

201
Q

Ilateral distension of the vagina is limited by the __ ___ and __ __

A

Ischial spines which project posteromedially and the sacrospinous ligaments extending from the spines to the lateral margins of the sacrum and coccyx

202
Q

The birth canal is deep ___ and narrow ___ . What does this cause

A

AP
Transversely

Fetus shoulders to rotate into the AP plane

203
Q

What can be palpated during a digital pelvic exam (vagina and or rectum)

A

Cervix, ischial spines, sacral promontory

204
Q

Pulsation of the __ arteries may be felt through the lateral parts of the fornix, as may irregularities of the ovaries, such as ___

A

Uterine

Cysts

205
Q

Pwhat may cause a vaginal fistulae

A

Obstetrical trauma during long and difficult labor may result in weaknesses, necrosis, or tears in the vaginal wall and sometimes beyond, radiation treatment for pelvic cancer, surgical complications, IBD, diverticulitis

206
Q

Traumas to the vagina may cause fistula connecting the vagina to what

A

Bladder, ureter, urethra, bowel, or rectum

207
Q

What fistula allow using to enter the bladder

A

Vesicovaginal
Ureterovaginal
Urethrovaginal

208
Q

Flow of urine into vagina is continuous with __ and __ fistula but occurs only during micturition from __ fistula

A

Vesicovaginal, ureterovaginal

Urethrovaginal

209
Q

What sort of vaginal fistula allow fecal matter or gas to enter vagina

A

Entero or rectovaginal fistula

210
Q

What is culdocentesis

A

Incision made int he posterior part of the vaginal fornix

211
Q

Why do a culdocentesis

A

Pelvic abscess in the rectouterine pouch can be drained

Or

Fluid in peritoneal cavity can be aspirated

212
Q

Laparoscopy of pelvic viscera

A

Insert laparoscope into the peritoneal cavity through a small incision below the umbilicus. Insufflation of carbon dioxide creates a pneumoperitoneum to provide space to visualize, and the pelvis is elevated so that gracvity will pull the intestines into the abdomen

213
Q

General anesthesia for birth

A

For emergency procedures

214
Q

Is the mother conscious if there is general anesthesia

A

No

215
Q

Under general anesthesia how does birth happen

A

Passively under the control of maternal hormones with the assistance os an obstetrician

216
Q

Regional anesthesia or analgesia

A

Epidural, spinal or pudendal block, affects one area of the body

217
Q

What is the mother consious of with regional analgesia

A

Yup. She is also conscious of uterine contractions and can bear down orpush to assist the contractions and expel the fetus.

218
Q

What is the mother conscious of with regional anesthesia

A

Induces complete block of pain and feeling and does not allow a woman to assist with labor

219
Q

Epidural block : where is indwelling catheter placed

A

Into epidural space (fat filled) at L3-L4

220
Q

How does epidural block work

A

Anesthesia bathes the spinal nerve roots , including the pain fibers from the uterine cervix and superior vagina and the afferent fibers fromt he pudendal nerve.

221
Q

What is anesthetize with epidural

A

Entire birth canal, pelvic floor, majority of the perineum

LOWER LIMBS NOT AFFECTED

222
Q

Why is a mother aware of uterine contractions with an epidural block

A

The pain fibers from the uterine body (superior to the pelvic pain line) ascend to the inferior thoracic superior lumbar levels. So mother is aware of uterine contractions

223
Q

The spinal epidural space does not continue into the cranial cavity, so the anesthetic agent cant ascend beyond the __ __

A

Foramen magnum

224
Q

Spinal anesthesia

A

Anesthetic agent is introduced through the dura and arachnoid matter with a needle into the spinal subarachnoid space at L3-L4

225
Q

Where get anesthesia with spinal anesthesia

A

Perineum, pelvic floor, and birth canal
Also motor and sensory function of entire lower limbs as well as sensation of the uterine contractions are temporarily blocked

226
Q

Why use spinal anesthesia

A

Limited duration procedures, such as postpartum sterilization or forceps delivery or for second stage of labor

227
Q

How long does spinal anesthesia last

A

30-250 minutes

228
Q

If the labor is extended or the level of spinal anesthesia is inadequate can we readminister spinal anesthesia

A

May be hard…

229
Q

Spinal anesthesia: bs the anesthetic agent is heavier than CSF, it remains in the inferior spinal subarachnoid space while the patient is inclined. What happens if patient lies flat

A

Circulate into the cerebral subarachnoid space int he cranial cavity

230
Q

Severe spinal headache

A

From spinal anesthesia

231
Q

Get anesthetic headache with epidural

A

No

232
Q

Risk of both epidural and spinal anesthesia

A

CSF can leak out of subarachnoid space’;

233
Q

How get leak of CSF with epidural

A

Needle inadvertently pierces the dura and arachnoid mater

234
Q

How get leak of CSF with spinal anesthesia

A

Needle deliberately pierces the dura and arachnoid

235
Q

What happens when get CSF leak

A

Decreases pressure within the canal, which can lead to a severe headache.

236
Q

How can you treat headachefrom anesthesia

A

Autologous blood patch in which a small amount of patients blood is injected into the epidural space to fill the hole made by the needle

237
Q

Pudendal nerve block

A

Peripheral nerve block that gives anesthesia over s2-s4 dermatomes and the inferior quarter of the vagina

238
Q

Does pudendal nerve block, block pain from the superior birth canal (cervix and superior vagina)

A

No

239
Q

Can mother feel contractions with pudendal nerve block

A

Yop

240
Q

What removes support from the pelvic floor

A

Levator ani and/or pelvic fascia, which may occur during childbirth, or disruption of the perineal body

241
Q

Perineal body

A

Final support of the pelvic viscera, linking muscles that extend across the pelvic outlet, like crossing beams supporting the overlying pelvic diaphragm

242
Q

What can disrupt the perineal body

A

Trauma, inflammatory disease, and infection, which may result in the formation of the fistula of the vagina

243
Q

Prolapse of pelvic viscera can happen to what:

A 
Urethrocele
Cystocele
Uterovaginal prolapse
Rectocele
Enterocele
244
Q

Urethrocele

A

Prolapse of the lower anterior vaginal wall that involves only the urethra

245
Q

Cystocele

A

Prolapse of the anterior vaginal wall involving the bladder

246
Q

Uterovaginal prolapse

A

Prolapse of the uterus, cervix, or upper vagina

247
Q

Uterovaginal prolapse

A

Prolapse of the uterus , cervic, or upper vagina

248
Q

Rectocele

A

Prolapse of the lower posterior vaginal wall involving the rectum

249
Q

Enterocele

A

Prolapse of the upper posterior vaginal wall involving the rectovaginal pouch

250
Q

Pelvic organ prolapse quantification (POP-Q)

A

Quantifying and describing pelvic organ prolapse . Relies on measurements of non defined points

251
Q

What is the point of reference in POP-Q

A

Hymenal ring

252
Q

1st degree prolapse

A

Prolapse of the organ halfway to the hymen

253
Q

2nd degree prolapse

A

Prolapse of the organ to the hymen

254
Q

3rd degree prolapse

A

Prolapse of the organ past the hymen

255
Q

4th degree prolapse

A

Maximum descent of the organ

256
Q

Treatment for pelvic organ prolapse

A

Pelvic floor exercises (kegal)
Pessaries (devices inserted into he vagina to support the prolapsed organ)
Surgery

257
Q

Episiotomy

A

Surgical incision fo the perineum and inderoposterior vaginal wall used to enlarge the vaginal orifice, with intention of decreasing excessive traumatic tearing of the perineum and uncontrolled jagged tears of the perineal muscles

258
Q

When is episiotomy indicated

A

When descent of the fetus is arrested or protracted when instrumentation is necessary (forceps) or to expedite delivery when there are signs of fetal distress

259
Q

Median episiotomy

A

Incise perineal body
Scar will not be greatly different from fibrous tissue surrounding it.

Self limiting , resisting further tearing

260
Q

When further tearing occurs with median episiotomy

A

Directed toward the anus and the sphincter damage or anovaginal fistulae are potential sequelae

261
Q

What are median episiotomy associated with

A

Increased incidence of severe lacerations, associated in turn with an increased incidence of long term incontinence, pelvic prolapse and anovaginal fistulae

262
Q

Mediolateral episiotomies

A

Lower incidence of severe laceration and are less likely to be associated with damage to the anal sphincter and canal

263
Q

Incision in mediolateral episiotomies

A

Median incisive, which then turns laterally as it proceeds posteriorly, circumventing the perineal body and directing further tearing away from the anus

264
Q

What may rupture the intermediate part of the urethra in males

A

Fractures of the pelvic girdle, espicially those resulting from separation of pubic symphysi and puboprostatic ligaments

265
Q

Rupture of the intermediate part of the urethra results in what

A

Extravasion of urine and blood into the deep perineal pouch

266
Q

Fluid in the deep perineal pouch may pass where

A

Superiorly through the urogenital hiatus and distribute extraperitoneally around the prostate and bladder

267
Q

What is the common site of rupture of the spongy part of the urethra

A

Bulb of the penis

268
Q

Does spongy urethra rupture result in extravasion of urine

A

Yup

269
Q

How rupture spongy urethra

A

Forceful blow to the perineum, such as falling on a metal bean or incorrect passage of a transurethral catheter or device that fails to negotiate the angle of the urethra in the bulb

270
Q

What happens if rupture the corpus spongiform and spongy urethra

A

Urine passing from it into the superficial perineal space

271
Q

What determines the direction of flow of extravasated urine

A

Attachments of perineal fascia

272
Q

Urine may pass into the loose CT in the scrotum, around the penis, and superiorly , creep to the membranous layer of subcutaneous CT of the inferior abdominal wall. Where can urine not pass

A

Thigh bc the membranous layer of superficial perineal fascia blends with the fascia lata, enveloping the thigh muscles, just distal to the inguinal ligament

Posteriorly into the anal triangle bc the superficial and deep layers of perineal fascia are continuous with each other around the superioficl aperineal msucles and with the posterior edge of the perineal membrane between them,

273
Q

Rupture of a blood vessel inthe ___ __ __ resulting from trauma would results in similar containment of blood in the pouch

A

Superficial perineal pouch

274
Q

The fat bodies of the __-__ fossa are among the lsat reserves of fatty tissue to disappear with starvation

A

Ischio-anal

275
Q

In absence of support from ischio-anal fat, what is common

A

Rectal prolapse

276
Q

Pectinate line/dentate/mucocutaneous line

A

Approximates the level of important anatomical change related to transition from visceral to parietal, affecting things like metasticization

277
Q

Ischial-anal abscesses

A

Infection in ischio-anal fossa may cause abscess

Painful

278
Q

How may infections react the ischio-anal fossa

A

After cryptitis(inflammation of anal tissue

Extension from a pelvirectal abscess

After a tear in the anal mucous membrane
From a penetrating wound int he anal region

279
Q

Diagnostic signs of ischio anal abscess

A

Fullness and tenderness between the anus and the ischial tuberosity

280
Q

A peri-anal abscess may rupture

A

Opening into the anal canal, rectum, or peri-anal skin.

281
Q

Bc the is how-anal fossa communicate posteriorly through the _ __ __, an abscess in one fossa may spread to the other one and form what?

A

Deep postanal space

Horseshoe shaped abscess around the posterior aspect of the anal canal

282
Q

In chronically constipated persons, the anal __ and __ may be town by hard feces

A

Valves

Mucosa

283
Q

Anal fissure

A

Usually located in the posterior midline, inferior to the anal valves

284
Q

Why are anal fissures painful

A

Supplied by sensory fibers of the inferior rectal nerves

285
Q

A perinatal abscess may follow infection of an anal fissure, and the infection may spread where

A

Ischioanal fossa and form ischio anal abscesses or spread into the pelvis and form a pelvirectal abscess

286
Q

Anal fistula

A

May result from the spread of an anal infection and cryptitis

287
Q

Describe anal fistula

A

One end opens into the anal canal and the other end opensinto an abscess in the ischio anal fossa or into the peri anal skin

288
Q

Internal hemorrhoids

A

Prolapses of rectal mucosa containing the normally dilated veins of the internal rectal venous plexus

289
Q

What causes internal hemorrhoids

A

Breakdown of the mucularis mucosa, a smooth muscle layer deep to the mucosa

290
Q

Internal hemorrhoids that prolapse into or through the anal canal are often compressed by the contracted __, impeding blood flor

A

Sphincters. As a result they tend to strangulate or ulcerated

291
Q

Why is blood from internal hemorrhoids bright red

A

Blood from abundant anteriovenous anastomoses

292
Q

External hemorrhoids

A

Thrombosis in the veins of the external rectal venous plexus and are covered by skin

293
Q

Predisposing factors for hemorrhoids

A

Pregnancy, chronic constippation , prolonged toilet sitting, any disorder that impedes venous return, including increased intra abdominal pressure

294
Q

The anastomoses between the superior, middle and inferior rectal veins form clinically important communications between the _ and _ venous systems

A

Portal

Systemic

295
Q

The superior rectal vein drains into what

A

IMV

296
Q

The middle and inferior rectal veins drain into

A

Systemic systemic from the IVC

297
Q

Any abnormal increase in pressure int he valveless portal system of veins of the trunk may cause enlargement of the superior rectal veins, resulting in what

A

Increase in blood flow or stasis in the internal rectal venous plexus

298
Q

Portal hypertension that occurs in relation to hepatic cirrhosis, the __ anastomoses between the _ and _ veins amay become varicose

A

Portocaval

Middle and inferior rectal veins

299
Q

The veins of the rectal plexus normally appear ___

A

Varicose

300
Q

Internal hemorrhoids occur most commonly in the absence of __ __

A

Portal hypertension

301
Q

Anal canal superior to pectinate line

A

Visceral:innervated by visceral afferent pain fibers, so that an incision or needle insertion in this region is painless.

302
Q

Internal hemorrhoids are painful?

A

No

303
Q

Inferior to the pectinate line

A

Anal canal is somatic, supplied by the inferior anal (rectal) nerves containing somatic sensory fibers

304
Q

External hemorrhoids painful

A

Yup

305
Q

Anorectal incontinence

A

Stretching of the pudendal nerves during a traumatic childbirth can cause pudendal nerve damage and anorectal incontinence

306
Q

Urethral catheterization

A

Remove urine

307
Q

When inserting catheters or urethral sounds, what is important

A

The curves of the male urethra must be considered

308
Q

Just distal to the perineal membrane, the spongy urethra is well covered inferiorly and posteriorly by erectile tissue of the bulb of the penis, however a short segment of the __ part of the urethra is unprotected

A

Intermediate

309
Q

Bc the intermediate urethra is unprotected, what is a problem

A

Must negotiate the area bc urethral wall is thin so vulnerable to rupture from the insertion of urethral catheters and sounds

310
Q

The intermediate part or urethra is __ distendible

A

Least

311
Q

How does the intermediate part of the urethra run

A

Inferno-anteriorly as it passes through the external urethral sphincter. Proximally it takes a slight curve that is concave anteriorly as it transverse the prostate

312
Q

Urethral stricture

A

From external trauma of the penis or infection of the urethra.

313
Q

What are urethral sounds used for

A

Dilate the constricted urethra

314
Q

What is the narrowest and least distendible part of the urethra

A

External urethral orifice

315
Q

The scrotum is easily distended. What may enter the scrotum in an inguinal hernia

A

Intestines . Making it as large as a soccer ball

316
Q

Orchitis

A

Inflammation of the testes

317
Q

What causes orchitis

A

Mumps, bleeding in the subcutaneous tissue, or chronic lymphatic obstruction (elephantitis)

318
Q

Is it normal for one testicle to be slightly larger than the other

A

Yup

319
Q

Which testicle is usually more inferior

A

Left

320
Q

About half of testicular cancer occur between what ages

A

20-34

321
Q

Hypospadias

A

1/300

322
Q

Glandular hypospadias

A

External urethral orifice is on the ventral aspect of the glans penis

323
Q

Penile hypospadias

A

On body of penis

324
Q

Penoscrotal or scrotal hypospadias

A

In the perineum

325
Q

Embryological basis for hypospadias

A

Failure of urogenital folds to fuse on the ventral surface of the penis

326
Q

Hypospadias is associated with inadequate production of ___ by the fetal testes

A

Androgens

327
Q

Phimosis

A

Prepuce fits too tight over glans penis . Can’t be retracted

328
Q

Smegma

A

Oily secretions of cheesy consistency accumulate in the preputial sac, causing irritation

329
Q

Paraphimosis

A

Retraction fo the prepuce over the corona of the glans penis constricts the neck of the glans so much that there is interference with the drainage of blood and tissue fluid

330
Q

Circumcision

A

Surgical excision of the prepuce

331
Q

Impotence

A

Lesion of prostatic plexus or cavernous nerves

332
Q

How treat impotence

A

Surgically implanted , semirigid or inflatable penile prosthesis may assume the role of the erectile bodies

333
Q

Erectile dysfunction

A

Absence of nerve

Hypothalamus and endocrine disorders may reduce testosterone

334
Q

How can ED be overcome

A

Meds, injections that increase blood flow into the cavernous sinusoids by causing relaxation of SM

335
Q

Female genital cutting

A

Remove prepuce of clit and clit and labia minora and may include suturing of the vaginal ostium

336
Q

Why would you have female genital cutting

A

Inhibit sexual arousal and gratification

337
Q

Vulvar trauma happens how

A

Disruption of vessels as the result of trauma (athletic injuries such as jumping hurdles, sexual assault, obstetrical injury)

338
Q

Vulvar hematoma

A

PAINFUL
Blood in labia majora
Can lead to scarring and fistula

339
Q

When are the greater vestibular glands palpable

A

When infected

340
Q

Occlusion of the vestibular gland duct

A

Predispose the individual to infection of the greater vestibular gland

341
Q

The greater vestibular gland is the site of most vulva ____

A

Adenocarcinoma

342
Q

Bartholinitis

A

Inflammation of the greater vestibular (bartholinitis) glands

343
Q

What may cause bartholinitis

A

Pathogenic organism

344
Q

What may enlarged greater vestibular glands impinge

A

Wall of the rectum

345
Q

Occlusion of the vestibular gland duct without infection can result in the accumulation of ___

A

Mucin

Causing a bartholin gland cyst

346
Q

Pudendal nerve block

A

Injecting a local anesthetic agent into the tissues surrounding the pudendal nerve

347
Q

Where is the injection for a pudendal nerve block made

A

Where pudendal nerve crosses the lateral aspect of the sacrospinous ligament near its attachment to the ischial spine or in the initial part of the pudendal canal

348
Q

Why is it important that the physicians finger is always positioned between the needle tip and the baby’s head during pudendal nerve block

A

Fetus head usually stationed in lesser pelvis

349
Q

Ilio inguinal nerve block

A

Abolish sensation from the anterior part of the perineum

350
Q

When patients with pudendal or ilio inguinal nerve block complain of pain what is it from

A

Result of overlapping innervation by the perineal branch at the posterior cutaneous nerve of the thigh.

351
Q

Superficial transverse perineal muscle, bulbospongiosus, and external anal sphincter

A

Commonly attach to the perineal body, forming crossing beams over the pelvic outlet to support the perineal body and pelvic diaphragm

352
Q

Why are female perineal muscles underdeveloped in comparison to men

A

Absence of functional demands related to urination, penile erection, and ajaculation

353
Q

What do the female perineal muscles do

A

Support pelvic viscera and help prevent urinary stress incontinence and post partum prolapse of viscera

354
Q

Kegal

A

Use perineal muscles such as successive interruption of urine flow while urinating

355
Q

Vaginismus

A

Involuntary muscle spasms that occur when vaginal penetration is attempted

356
Q

Vaginismus may cause dyspareunia. What that

A

Painful intercourse

357
Q

Vaginismus can be __

A

Psychological

358
Q

Treatment for vaginismus

A

Muscle relaxation techniques and desensitization with the use of vaginal dilatory of increasing diameter

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