Repro Flashcards
What is the acetabulum?
The socket for the hip joint
What is the obturator foramen largely closed off by?
The obturator membrane
What makes up the pubic arch?
2 ischo pubic rami coming together at the pubic symphysis
What forms the floor of the inguinal canal?
The inguinal ligament
What forms the lateral surface of the pelvic inlet?
The pectin pubis
What forms the posterior wall of the pelvic inlet?
Ala of sacrum and sacral promontory
Function of Greater pelvis
Supports abdominal viscera
Another name for greater pelvis
False pelvis
Another name for lesser pelvis
True pelvis `
What part of the pelvis is the pubic tubercle located beside?
The pubic symphysis
Posterior border of pelvic outlet
tip of coccyx
Lateral border of pelvic outlet
ischial tuberosities
inferior margin of sacrotuberous ligament
Anterior border of pelvic outlet
Pubic arch
Subpubic angle in females
> 90
Subpubic angle in males
< 90
What type of joint is the sacroiliac joint?
Synovial plane
What type of joint is the pubic symphysis?
secondary cartilaginous
What is the narrowest diameter of the female pelvic outlet?
> 11 cm
What is the function of the sacrotuberus and the sacrospinous ligaments?
Both strengthen the sacroiliac joint
What do the sacrotuberus and sacrospinous ligaments crossing form?
Greater and lesser sciatic foramen
Where does the piriformis attach and go?
From sacrum
Through greater sciatic foramen
To greater trochanter of the femur
Action of the piriformis
Lateral hip rotation
Action of obturator internus
Lateral hip rotation
Where does the obturator internus attach and go?
Arises from obturator membrane and the area around
Goes through the lesser sciatic foramen
Attaches to the greater trochanter of the femur
Where does the sacral plexus lie?
On the posterior wall of the pelvis
Function of the pelvic floor
Divides the pelvis from the perineum
Supports the pelvic viscera
What are the components of the pelvic floor?
Levator ani muscles
Coccygeus
Fascia covering the muscles
Where does the coccygeus attach?
Edge of ischial spine and coccyx
Where does the levator ani attach?
Body of the pubis to the ischial spine
Function of levator ani
Supports pelvic viscera
Maintain urinary continence
What are the levator ani muscles?
Iliococcygeus
Pubococcygeus
Puborectalis
What does the puborectalis form?
The anorectal sling
What space is the ischiorectal fossa found in?
Space between the
- ischial tuberosity
- sacrotuberus ligament
- underside of levator ani
What is the ischiorectal fossa full of?
Fat
What is the ischiorectal fossa transversed with?
Nerves
Vessels
What area is the urogenital hiatus?
Area between the ischio-pubic rami
Contents of the urogenital hiatus
Dorsal vein of clitoris / penis
Urethra
Vagina
Innervation of the pelvic diaphragm/floor
Pudendal nerve
What is a cystocele?
Prolapsed bladder through vagina
What is a rectocele?
Front wall of rectum bulges into back of vagina
Function of an episiotomy
Prevents uncontrolled tearing of the perineal body
What is the most favourable direction of an episiotomy?
Mediolateral
The perineum is the whole area between…..
coccyx
Ischial tuberosity
Pubic symphysis
Where does the sciatic nerve emerge?
Just below the piriformis
What does the tunica vaginalis contain?
Visceral and parietal layers containing fluid
Branches of the superior gluteal artery
Internal pudendal artery
Middle rectal artery (supplying lower part of rectum)
Trajectory of the internal pudendal artery
Goes out the greater sciatic foramen
Wraps around the sacrospinous ligament
Goes back in through the lesser sciatic foramen
Branches of the internal iliac artery
Superior and inferior vesical arteries Uterine artery Middle and inferior rectal arteries Internal pudendal artery Obturator artery
What do the superior and inferior vesicle arteries supply?
Bladder
Seminal gland
Prostate
Function of an episiotomy
Prevents uncontrolled tearing of the perineal body
What is the most favourable direction of an episiotomy?
Mediolateral
The perineum is the whole area between…..
coccyx
Ischial tuberosity
Pubic symphysis
Where does the sciatic nerve emerge?
Just below the piriformis
What does the tunica vaginalis contain?
Visceral and parietal layers containing fluid
Branches of the superior gluteal artery
Internal pudendal artery
Middle rectal artery (supplying lower part of rectum)
Trajectory of the internal pudendal artery
Goes out the greater sciatic foramen
Wraps around the sacrospinous ligament
Goes back in through the lesser sciatic foramen
Branches of the internal iliac artery
Superior and inferior vesical arteries Uterine artery Middle and inferior rectal arteries Internal pudendal artery Obturator artery
What do the superior and inferior vesicle arteries supply?
Bladder
Seminal gland
Prostate
What does the uterine artery supply?
Uterus
What is the main artery to the perineum?
Internal pudendal artery
What does the obturator artery supply?
Thighs
Adductor region
Where do the gonadal arteries arise from?
The abdominal aorta
What are the gonadal arteries?
Testicular arteries
Ovarian arteries
Where does the superior rectal artery come from?
The inferior mesenteric artery
Where does the vaginal artery come from?
The uterine artery
Venous drainage of pelvis
Internal iliac veins superior rectal vein median sacral vein gonadal veins internal vertebral veins
What does the prostatic venous plexus communicate with on the posterior side?
The vertebral venous plexus
Where does the upper 1/3rd of the rectum drain?
The portal circulation
Where does the lower 2/3rds of the rectum drain?
Systemic circulation
Innervation of skin at root of penis and labia
Ilioinguinal nerve
Nerve root of ilioinguinal nerve
L1
Where does the ilioinguinal nerve enter at?
The superficial inguinal ring
Innervation of anterior scrotum and sensation to upper thigh
Genital branch of genitofemoral nerve
Nerve roots of the genital branch of the genitofemoral nerve
L1-2
Where does the genital branch of the genitofemoral nerve enter at?
The deep inguinal ring
Nerve roots of the pudendal nerve
S2-S4
What does the pudendal nerve follow?
The pudendal artery
What does the pudendal nerve split into?
Inferior rectal nerve
Dorsal nerve of penis
Scrotal nerve
What are the erectile structures?
Clitoris or bulb of vestibule
Corpora cavernosa of penis
What is used as a bony landmark for pudendal nerve block?
Ischial spine
When would a pudendal nerve block be used?
In childbirth
Autonomic supply to the pelvic organs is via what?
The pelvic plexus
What innervates the vas deferens, the seminal vesicles, the prostate and the epididymis?
Sympathetic L1, L2 via hypogastric plexus
What innervates the female genital tract?
Sympathetic from pelvic and ovarian plexuses
Parasympathetic from S2-S4
What innervates erectile tissues in both male and female?
Parasympathetic from S2-S4 via hypogastric plexus
Innervation of the cremaster muscle
Genital branch of genito femoral nerve
What does the bulbospongious cover in females?
The vestibular gland
What are the erectile structures?
Clitoris or bulb of vestibule
Corpora cavernosa of penis
What is there a risk of during rectal surgery?
Failure to ejaculate due to injury to sympathetic nerves responsible for ejaculation
What are ovoid testes suspended in the scrotum by?
The spermatic cords
What do internal iliac lymph nodes drain?
Gluteal region Deep structures of penis Deep perineum Inferior pelvic viscera Prostate Seminal vesicle
What do the sacral nodes drain?
Postero-inferior pelvic structures
Inferior rectum
Prostate
What do the common iliac vessels drain?
External lymph nodes
Internal lymph nodes
Sacral lymph nodes
Function of the testis being outside of the body
Decreased temperature for sperm production
Contents of the spermatic cord
Blood vessels
Vas deferens
Nerves
Lymph vessels
What blood vessels are present in the spermatic cord?
Testicular artery
Pampiniform plexus
What nerves are present in spermatic cord?
Autonomic
Genital branch of genitofemoral nerve
What is hydrocele?
Collection of fluid around the testis
What is haematocele?
Collection of blood around the testis
Where do the testicular arteries arise?
L2
Lymphatic drainage of testis
Lumbar nodes
Para-aortic nodes
What do the testicular arteries cross?
Ureter
Lower part of external iliac artery
Function of the pampiniform plexus
Testes temperature regulation
Where do the right testicular vein drain into?
IVC
What does the prostate produce?
Prostate fluid - a main component (50% of semen)
Parts of the urethra
Pre-prostatic
Prostatic
Membranous
Spongey
What is varicocele?
Enlargement of veins in the scrotum
What does the vas deferens form?
Ejaculatory duct
What do the seminal vesicles produce?
Semen
What does semen contain?
Fructose
What does the prostate produce?
Prostate fluid - a main component (50% of semen)
What does prostate fluid contain?
Citric acid
Proteolytic enzymes
Another name for bulbourethral glands
Cowpers glands
Where is the bulbourethral glands found?
In the urogenital diaphragm
Histology - What is found in the lumen of the seminiferous tubules in the testis?
Spermatozoa
Function of bulbourethral glands
Produce pre-ejaculate/mucus during sexual arousal
What is pre-ejaculate?
An alkaline mucous secretion that is produced in response to sexual stimulation to help protect sperm during ejaculation as it passes through the urethra
Lymphatic drainage of scrotum
Superficial inguinal lymph nodes
Lymphatic drainage of skin of penis
Superficial inguinal lymph nodes
Histology - What cells are found in the testis in the interstitial spaces between the tubules?
Leydig cells
What is seen on the histology of the prostate?
Serous alveoli with infolding epithelium
What does the broad ligament connect to?
Connected to both uterus and ovaries
Ovary to lateral pelvic wall
Appearance of seminal vesicles on histology
Highly recessed irregular lumen forming crypts and cavities giving a honeycomb appearance
Well developed muscular externa
Appearance of ductus deferens on histology
Lumen stellate in shape (star)
Thick walled muscular tube
Longitudinal folds
3 layers of the uterus
Perimetrium
Myometrium
Endometrium
Function of the broad ligament
Keeps the uterus central
What does the ovarian ligament lie within?
The broad ligament
What does the ovarian ligament connect to?
Connects ovary to the side of the uterus (just below origins of fallopian tube)
What does the round ligament attach to?
Origin uterine horns
Attaches to the labia majora
Passes through the inguinal canal
What is the suspensory ligament of the ovary?
A fold in the perineum
What does the suspensory ligament contain?
Ovarian vessels and nerves
What is the round ligament of the uterus a remnant of?
Embryonic gubernaculum
What does the round ligament attach to?
Origin uterine horns
Attaches to the labia majora
What does the cardinal ligament / lateral cervical ligament attach to?
Base of broad ligament
Extends from cervix to lateral pelvic wall
What does the cardinal ligament contain?
Uterine arteries and veins
What does the uterosacral ligament connect to?
Extends from cervix to sacrum
Normal position of the uterus
Anteverted
Anteflexed
What part of the uterus is the lower segment of the uterus formed from in pregnancy?
Isthmus and cervix
What is a C section?
Uterus opened at lower segment with a transverse incision
Another name for the rectouterine pouch
Pouch of Douglas
What can a retroverted retroflexed uterus result in, especially in early pregnancy?
Uterine prolapse
Why is it important in the surgical management of miscarriage to know the position of the uterus?
To minimise the risk of perforation of the uterus with instrumentation
What part of the fallopian tube is the longest and widest?
Ampulla
What is the posterior fornix used for clinically?
can access pouch of douglas for culdocentesis
Ligaments of support to the uterus
Cardinal/lateral cervical ligament
Pubocervical ligament
Sacrocervical ligament (fascial)
Pelvic diaphragm
Where does fertilisation occur?
In the ampulla
What does the ovarian artery supply and via what?
Ovaries
Via the broad ligament
Where do the gonadal arteries arise from?
The gonadal arteries
What does the ovarian artery supply and via what?
Ovaries
Via the broad ligament
What do the ovarian arteries descend in?
The suspensory ligament of the ovary
What is the uterine artery a branch of?
internal iliac artery
Function of bartholins gland
Secrete mucus to lubricate the vagina
Where does the uterine artery cross the ureter?
At the level of the ischial spine at the junction of the cervix and lateral fornices of the vagina
Journey of the uterine artery
Crosses of ureter
Where does the uterine artery cross the ureter?
At the level of the ischial spine at the junction of the cervix and lateral fornices of the vagina
When is the ureter commonly injured?
During hysterectomy
What are the labia and distal vagina drained by?
Superficial inguinal lymph nodes
What are the ovaries drained by?
Para-aortic nodes
What are the fundus and upper uterine body drained by?
Pre/para-aortic nodes
What are the most part of the uterine body drained by?
External iliac lymph nodes
What is the uterine cervix and upper vagina drained by?
Internal iliac nodes
Sacral (opening of cervix)
What is the lower vagina drained by?
Superficial inguinal nodes
How many lobes does the breast have?
15-25 lobes
What is the parenchyma of the breast?
Tubuloacinar gland
Surface anatomy of the breast
2nd - 6th rib
Horizontally from lateral border of sternum to the mid axillary line
What lies on the deep surface of the breast?
Pectoralis major
Serratus anterior
External oblique
Subclavian and axillary artery branches to supply the breast
Lateral thoracic artery
Internal thoracic artery
(same veins)
Main lymphatic groups draining the breast
Axillary nodes
Pectoral nodes
Supraclavicular nodes
Divisions of the axillary nodes
Apical Infraclavicular Parasternal Subscapular Humeral
Histology - in active breast (pregnancy), what is adipose tissue replaced by?
Glandular tissue
What is seen on the foetal side of the placenta?
Umbilical vessels
Amnion
Smooth
Bears attachment of umbilical cord
What are the two sides of the placenta?
Foetal
Maternal
What are seen on the maternal side of the placenta?
Rough
Spongey
Cotyledon
Grooves
What is found in a cross section of the umbilical cord?
2 umbilical arteries
Umbilical vein
Wartons jelly
What do umbilical arteries carry?
Deoxygenated nutrient depleted blood from the foetus to the placenta
What persists during foetal circulation?
Left umbilical vein
What do umbilical veins carry?
Oxygen nutrient rich blood from the placenta to the foetus
What two triangles are found in the perineum?
Urogenital triangle
Anal triangle
Where is the urogenital triangle found?
Inferior to pubic symphysis
Where is the anal triangle found?
Anteroinferior to coccyx
Where does the perineal fascia attach?
Stretches between right and left sides of the pubic arch, below the pubic symphysis
Anterior border of the perineum
Pubic symphysis
Posterior border of the perineum
Tip of coccyx
Lateral borders of the perineum
Inferior pubic rami
Inferior ischial rami
Sacrotuberous ligament
What makes up the roof of perineum?
Pelvic floor
What makes up the base of the perineum?
Skin and fascia
What are the perineal muscles?
Ischiocavernous
Bulbospongiosus
External anal sphincter
Transverse perineal muscle
Function of the external anal sphincter
Keeps the anal canal and orifice shut
Innervation of external anal sphincter
Perineal branches of Pudendal nerve
Innervation of bulbospongiosus
Pudendal nerve
Function of bulbospongiosus
In males - removal of residual urine from urethra after urination and pulsatile emission of semen during ejaculation
Compress urethra
Closes vaginal canal in females
Facilitates ejection of clitoris
Innervation of ischiocavernous
Pudendal nerve
Innervation of superficial and deep transverse muscles
Pudendal nerve
Function of the superficial and deep transverse muscles
Stabilises position of the perineal body
Innervation of the external urethral sphincter
Perineal branches of pudendal nerve
Function of external urethral sphincter
Compress urethra to maintain urinary continence
What lies over the anterior perineal muscles?
Perineal fascia
Function of the perineal body
Point of attachment for muscle fibres of the pelvic floor and perineum.
Final support of pelvic viscera
Muscles that converge at the perineal body
Superficial and deep transverse perineal muscles
Bulbospongiosus
Levator ani
External anal sphincter
What are the superficial and deep perineal pouches?
Fascia limited, potential spaces transversed by the urethra
What can the superficial and deep perineal pouches by infiltrated by and when?
Urine
Following injury to the urethra
Where is the external urethral sphincter found?
Subcutaneous perineal space
Where is the internal urethral sphincter found?
Superficial perineal space
What is found in the deep perineal pouch?
Deep transverse perineal muscle
What is found in the superficial perineal pouch?
Crus of penis (corpus cavernosum)
Corpus spongiosus
Urethra
Widest part of male urethra
Prostatic
Narrowest part of male urethra
Membranous
Function of the ischio-anal/rectal fossa
Allows the anal canal to expand during defaecation
What is found in the ischio-anal/rectal fossa
Alcock’s canal
Where does the ischio-anal/rectal fossa lie?
Inferior to pelvic floor
Lateral to anal canal
Whats another name for alcocks canal?
Pudendal canal
Where does the pudendal canal go through?
Lesser sciatic foramen
What is found inside the pudendal canal?
Internal pudendal artery
Internal pudendal vein
Pudendal nerve
What is found outside the pudendal canal?
Inferior rectal artery
Inferior rectal vein
Inferior anal nerves
Fatty tissue
What does the internal pudendal vein drain?
Receives veins from urethral bulb, perianal and inferior haemorrhoid veins
What does a ischio-anal abscess lead to?
Fistula
Function of ischiocavernosus muscle
Stabilises erect penis
Tense vagina during orgasm
Compresses crus penis and retards the return of the blood through the veins therefore organ maintains erect
Function of Sertoli cells
Support and nourish developing spermatozoa
Function of epididymis
Accumulation, storage and maturation of spermatozoa
Epithelium of epididymis
Pseudostratified epithelium
Epithelium of ductus deferens
Pseudostratified columnar
Epithelium of vagina
Stratified squamous non keratinising epithelium
Function of the placenta
Metabolism - synthesis of glycogen
Transports of gases and nutrients
Endocrine secretion - HCG
What is the upper segment of the uterus formed from in pregnancy?
Body of uterus
Why does childbirth commonly injure the pelvic floor during childbirth?
Due to weaknesses at the perineal body
Why may an episiotomy minimise long term damage?
Bleeds quickly but heals quicker
What can be felt in a rectal exam in males and females?
M = prostate F = tampon
Why might haemorrhoids be Assosiated with cirrhosis of the liver?
Liver cirrhosis causes portal HTN which could cause haemorrhoids
Why might an enlarged prostate cause retention of urine?
Obstructs the urinary tract at the urethra
What is meant by a tubal/ectopic pregnancy?
Egg implants outwith the uterine cavvity
After pregnancy what may happen to the ovary?
It may be displaced
After ageing, what may happen to the ovary?
Atophy and fibrous
What does the placenta develop from?
The trophoblast following implantation of the blastocyst into the uterine endometrium
What does the placenta form?
A link for physiological exchange between maternal and foetal circulation
When does the placenta physiologically separate from the uterine wall?
Third stage of labour after delivery of the foetus
Function of vas deferens
Transports sperm from epididymis to urethra
What is affixed to the perineal membrane?
External genitalia
Function of episiotomy
To prevent uncontrolled tearing of the perineal body
To prevent extension of perineal tear into the anal sphincter
What can happen if the prostate of men becomes enlarged?
Urinary retention
Why does the ischo-anal/rectal fossa often a site for abscess formation?
Poorly vascularised
Vulnerable to infection from anal canal