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Year 3 anatomy > Repro Anatomy 1 > Flashcards

Repro Anatomy 1 Flashcards

1
Q

On the below diagram locate the following bony landmarks that make up the superior pelvic aperture (pelvic inlet/pelvic brim)

A

A

Sacral Promontory

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2
Q

On the below diagram locate the following bony landmarks that make up the superior pelvic aperture (pelvic inlet/pelvic brim)

B

A

Ala of Sacrum

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3
Q

On the below diagram locate the following bony landmarks that make up the superior pelvic aperture (pelvic inlet/pelvic brim)

C

A

Pubic Tubercle

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4
Q

On the below diagram locate the following bony landmarks that make up the superior pelvic aperture (pelvic inlet/pelvic brim)

D

A

Pubis Symphysis

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5
Q

On the below diagram locate the following bony landmarks that make up the superior pelvic aperture (pelvic inlet/pelvic brim)

E

A

Arcuate Line of Ilium

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6
Q

On the below diagram locate the following bony landmarks that make up the superior pelvic aperture (pelvic inlet/pelvic brim)

F

A

Pecten Pubis

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7
Q

On the below diagram locate the following bony landmarks that make up the superior pelvic aperture (pelvic inlet/pelvic brim)

G

A

Pubic Crest

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8
Q

The pelvic outlet is the inferior opening of the pelvis and is formed by bony features and ligaments

A

A

Inferior Margin of Pubic Symphysis

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9
Q

The pelvic outlet is the inferior opening of the pelvis and is formed by bony features and ligaments

B

A

Sacro-tuberous Ligaments

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10
Q

The pelvic outlet is the inferior opening of the pelvis and is formed by bony features and ligaments

C

A

Inferior Rami of Pubis

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11
Q

The pelvic outlet is the inferior opening of the pelvis and is formed by bony features and ligaments

D

A

Tip of Coccyx

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12
Q

what is the true pelvis?

A

(lesser pelvis)

below the pelvic brim between the pelvic inlet and the pelvic floor

located superiorly, it provides support of the lower abdominal viscera (such as the ileum and sigmoid colon). It has little obstetric relevance.

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13
Q

what is the false pelvis?

A

(greater pelvis)

above and in front the pelvis brim

located inferiorly. Within the lesser pelvis reside the pelvic cavity and pelvic viscera

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14
Q

what type of joint is the Sacroiliac joint?

A

Synovial

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15
Q

what type of joint is the Pubic Symphysis?

A

Secondary Cartilaginous

a secondary cartilaginous joint (a joint made of hyaline cartilage and fibrocartilage) located between the left and right pubic bones near the midline of the body

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16
Q

which is the male pelvis and which is the female pelvis?

A

left is male pelvis and right is female pelvis

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17
Q

Lesser pelvis (pelvis minor)

what is it like in males and females?

A

female - wide and shallow

male - narrow and deep

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18
Q

Pelvic inlet

what is it like in males and females?

A

female - oval shaped + rounded

male - heart shaped

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19
Q

Pelvic outlet

what is it like in males and females?

A

female - comparatively larger for child birth

male - Comparatively smaller

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20
Q

Subpubic angle

what is it like in males and females?

A

female - Obtuse: Greater than 90o

male - Acute: Less than 90o

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21
Q

Acetabulum:

what is it like in males and females?

A

female - small

male - large

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22
Q

Obturator foramen:

what is it like in males and females?

A

female - oval

male - round

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23
Q

With regards to the female pelvis and normal vaginal delivery:

What is the narrowest diameter of the pelvic inlet?

What is the narrowest diameter of the pelvic outlet?

A

13cm

11cm

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24
Q

The pelvic cavity has an antero-inferior wall, two lateral walls and a posterior wall.

The anterior-inferior wall is formed by the bodies and rami of the pubic bones and the pubic symphysis.

A
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25
Q

Which muscle is present in the posterior wall of the pelvis?

A

Piriformis and coccygeus

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26
Q

what is labelled?

A

sciatic nerve

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27
Q

what are the nerve roots of the sciatic nerve?

A

A combination of 5 nerve roots that exit from inside the lower lumbar and upper sacral spine - L4, L5, S1, S2, and S3

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28
Q

Which nerve network lies on the muscle forming the posterior wall of the pelvis?

A

sacral plexus

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29
Q

A

A

Levator ani – pubococcygeus

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30
Q

B

A

Levator ani – iliococcygeus

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31
Q

C

A

Puborectalis

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32
Q

D

A

Anococcygeal ligament

33
Q

E

A

Perineal body (female)

34
Q

what is the perineal body?

A

fibromuscular node lying in the midline of the perineum. It is pyramidal in shape and provides an anchor point for several of the muscles within the perineum

35
Q

anococcygeal body?

A

the ligament runs in the midline between the inferior two segments of the coccyx and the posterior aspect of the rectum

36
Q

2 muscles make up the majority of the pelvic floor – one of these has 3 separate paired muscles

what are the 2 muscles?

A

coccygeus muscle

levator ani muscles (3 paired seperate muscles)

37
Q

Give two functions of the pelvic diaphragm/floor

A

1) Support of abdominopelvic viscera
2) Resistance to increases in intra-pelvic/abdominal pressure
3) urinary and faecal continence

38
Q

What is the innervation of the pelvic diaphragm/floor?

A

anterior ramus of S4 and branches of pudendal nerve (roots S2, S3 and S4)

39
Q

what is a cystocele?

A

prolapsed, herniated, dropped or fallen bladder – ligaments that hold up bladder and muscles between a women’s vagina and bladder stretches or weakens, allowing bladder to sag into the vagina

40
Q

what is a rectocele?

A

herniation of the front wall of the rectum into the back wall of the vagina

41
Q

Clinical – Pelvic Floor Injury

Injury to pelvic floor during childbirth is common and potentially damaging.

Why?

A

Can lead to incontinence (stress incontinence)

42
Q

Why may an episiotomy minimise long-term damage?

A

Can help to prevent a severe tear of the perineum or speed up delivery

43
Q

Why is a mediolateral episiotomy preferable to a midline episiotomy?

A

Lower risk of third and fourth degree laceration. Can lead to faecal incontinence

44
Q

what is A and B?

A

bladder

45
Q

what is C and D?

A

prostate

uterus, ovaries

46
Q

what is E and F?

A

Rectum

47
Q

Clinical – Digital Rectal Examination

As part of the clinical examination of the abdomen, a digital rectal examination (DRE) forms an important aspect of formulation of a diagnosis.

What structures can be palpated when performing a DRE (in males and in females)

A

Male: Prostate(, seminal vesicles, bladder)

Female: Cervix

48
Q

Branches of the right and left internal iliac artery distribute blood to most of the pelvic organs, perineum and gluteal region except the testis, ovary and upper part of rectum.
Label the main branches of internal iliac artery on the image below

A

A

Common iliac artery

49
Q

Branches of the right and left internal iliac artery distribute blood to most of the pelvic organs, perineum and gluteal region except the testis, ovary and upper part of rectum.
Label the main branches of internal iliac artery on the image below

B

A

Internal iliac a.

50
Q

Branches of the right and left internal iliac artery distribute blood to most of the pelvic organs, perineum and gluteal region except the testis, ovary and upper part of rectum.
Label the main branches of internal iliac artery on the image below

C

A

Umbilical artery

51
Q

Branches of the right and left internal iliac artery distribute blood to most of the pelvic organs, perineum and gluteal region except the testis, ovary and upper part of rectum.
Label the main branches of internal iliac artery on the image below

D

A

Superior vesical arteries

52
Q

Branches of the right and left internal iliac artery distribute blood to most of the pelvic organs, perineum and gluteal region except the testis, ovary and upper part of rectum.
Label the main branches of internal iliac artery on the image below

E

A

Posterior division of the internal iliac artery

53
Q

Branches of the right and left internal iliac artery distribute blood to most of the pelvic organs, perineum and gluteal region except the testis, ovary and upper part of rectum.
Label the main branches of internal iliac artery on the image below

F

A

Anterior division of internal iliac

54
Q

Branches of the right and left internal iliac artery distribute blood to most of the pelvic organs, perineum and gluteal region except the testis, ovary and upper part of rectum.
Label the main branches of internal iliac artery on the image below

G

A

Inferior gluteal

55
Q

Branches of the right and left internal iliac artery distribute blood to most of the pelvic organs, perineum and gluteal region except the testis, ovary and upper part of rectum.
Label the main branches of internal iliac artery on the image below

H

A

Internal pudendal

56
Q

the terminal branches of the internal iliac artery:

Arteries of pelvis - Superior and inferior vesical

What is its distrubution/organ and what is its origin/branch of?

A

Bladder, seminal gland and prostate in males (and ureter)

anterior division of the internal iliac artery

57
Q

the terminal branches of the internal iliac artery:

Arteries of pelvis - uterine artery

What is its distrubution/organ and what is its origin/branch of?

A

branches to the cervix and the vagina, small vessels to the uterine tube and the round ligament of the uterus

only in female, anterior division of internal iliac

58
Q

the terminal branches of the internal iliac artery:

Arteries of pelvis - Gonadal (testicular or ovarian)

What is its distrubution/organ and what is its origin/branch of?

A

testicular = testes, within abdomen they supply the perirenal fat, ureter and iliac lymph nodes, within the spermatic cord, they supply the cremaster muscles

Ovarian = uterus, ovary, ureter, skin of labia and inguinal region, receives lymph form the lumbar lymph nodes

aorta

59
Q

the terminal branches of the internal iliac artery:

Arteries of pelvis - Superior rectal artery

What is its distrubution/organ and what is its origin/branch of?

A

sigmoid colon, rectum and anal canal

terminal branch of the inferior mesenteric artery

60
Q

the terminal branches of the internal iliac artery:

Arteries of pelvis - Middle and inferior rectal

What is its distrubution/organ and what is its origin/branch of?

A

middle = lower rectum, inferior = anal skin and musculature, skin of the buttock

internal iliac

61
Q

the terminal branches of the internal iliac artery:

Arteries of pelvis - Vaginal

What is its distrubution/organ and what is its origin/branch of?

A

vagina, bulb of the vestibule, fundus of the bladder, contiguous part of the rectum

uterine artery

62
Q

the terminal branches of the internal iliac artery:

Arteries of pelvis - Internal pudendal

What is its distrubution/organ and what is its origin/branch of?

A

Main artery to perineum

internal iliac

63
Q

the terminal branches of the internal iliac artery:

Arteries of pelvis - Obturator

What is its distrubution/organ and what is its origin/branch of?

A

pelvic muscles and hip joint

internal iliac

64
Q

The venous drainage of the pelvic structures is complex and involves interplay between the portal and systemic circulations. This has clinical significance especially in some pathologies e.g. liver cirrhosis, pelvic cancers

There are many venous plexuses formed in relation to pelvic organs (for example: rectal, prostatic) – some of these have clinical significance (e.g. prostatic venous plexus)

Which part(s) of the rectum drain(s) into the portal circulation?

Which part(s) of the rectum drain(s) into the systemic circulation?

A

superior

middle and inferior

65
Q

What is the significance of understanding the venous drainage of the rectum?

A

may cause haemorrhoids in liver cirrhosis portal systemic anastomosis is there

66
Q

Why might haemorrhoids be associated with cirrhosis of the liver?

A

due increased to increased portal pressure

67
Q

The veins along the sides and base of the prostate join to form the prostatic venous plexus.

This makes the prostate a very vascular organ – important to consider the risks of bleeding associated with operations in the area.

With which venous plexus does the prostatic venous plexus communicate with on its posterior side?

Why is this important – think of how prostate cancer spreads…?

A

internal vertebral venous plexus

it can spread to bones easy, spreads to spinal cord

68
Q

Nerve Supply to the Reproductive Organs

Somatic Nerves

The ___________ _____ originates from L1 and enters the inguinal canal at the _________ inguinal ring to supply skin at the root of the penis in the male and the labia in the female.

The __________ nerve originates at L1-2 and enters at the ____ inguinal ring.

A

ilioinguinal nerve

superficial

genitofemoral

deep

69
Q

What structure(s) in the male are supplied by the genital branch of the genitofemoral nerve?

A

cremaster muscle and anterior scrotal skin

70
Q

The pudendal nerve arises from the _____ plexus and follows the course of the pudendal artery to innervate the skin and the muscles of the perineum.

A

sacral

71
Q

From which segmental level(s) does the pudendal nerve arise?

A

S2-4

72
Q

note how the pudendal nerve travels from pelvis to perineum, via the gluteal region. This arrangement is essential to understand in bilateral pudendal nerve block for pain relief during childbirth, particularly for an instrumental (e.g. forceps) assisted vaginal birth

What bony landmarks are used when performing a pudendal nerve block during labour?

A

ischial spine

73
Q

The autonomic nerve supply to the pelvis originates from the where?

A

pelvic plexus (or inferior hypogastric)

The sympathetic fibres originate from L1 and L2 via the hypogastric nerve and terminal aspect of the sympathetic trunk.

These fibres hitchhike on the arterial supply to reach their target organs.

They provide sympathetic supply to all internal pelvic organs.

In a male they supply the vas deferens, seminal vesicles, prostate and epididymis.

In a female they supply the ovaries, uterus, fallopian tubes and vagina.

Parasympathetic fibres in the pelvis originate from the pelvic splanchnic nerves (S2 to S4). In addition to providing parasympathetic supply to all the internal pelvic organs, they innervate erectile tissues in both male and female.

74
Q

Confusing Splanchnics…

It is very easy to get confused when describing “splanchnic” nerves, as both parasympathetic and sympathetic nerves can be described as such

In the thorax the greater, lesser and least splanchnic nerves are ____________

In the pelvis the pelvic splanchnic nerves are ________________

A

sympathetic

parasympathetic

75
Q

Applied clinical question:

After rectal surgery, why are some men unable to ejaculate?

Which part of the autonomic nervous system has been affected?

A

damage to sympathetic fibres

sympathetic, L1 and 2 sympathetic fibres

76
Q

Lymphatics of the Pelvis

There are four primary nodes present in the pelvis receiving the lymphatic drainage of the pelvic organs. They are variable in number, size and location.

Remember that the lymphatic drainage of the pelvis tends to follow the arterial supply

Lymph node group in the pelvis - what pelvic area do the extenral iliac lymph nodes drain?

A

directly from pelvic structures, inguinal lymph nodes

77
Q

Lymph node group in the pelvis - what pelvic area do the internal iliac lymph nodes drain?

A

Gluteal region, deep perineum and inferior pelvic viscera

78
Q

Lymph node group in the pelvis - what pelvic area do the sacral lymph nodes drain?

A

posteroinferior pelvic viscera

79
Q

Lymph node group in the pelvis - what pelvic area do the common iliac lymph nodes drain?

A

Drainage from the three main groups: external, internal and sacral lymph nodes

Year 3 anatomy (12 decks)

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