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89 Cards in this Set
- Front
- Back
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what happens to the uterus during the first trimester?
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-uterine hypertrophy (walls thicken)
-shape becomes more globular - by end, it fills the pelvis |
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what happens to the cervix during pregnancy?
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elaboration of the mucosa into a honeycomb-like structure, filled w/a tenacious mucus plug
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what induces the changes in the cervix during pregnancy?
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hormones
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changes to the urinary system during the first trimester
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--kidneys increase in size
--ureteral dilatation (due to compression by uterus & ovarian veins, as wall as progesterone) --bladder compression by expanding uterus |
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changes to breast during first trimester
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in the early weeks, hormones cause vascular engorgement
weight and size of breast increases by third month, hypertrophy of the breast nipples enlarge and the areola begins to darken |
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changes to the respiratory system in first trimester
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configuration of the thorax changes (subcostal angle increase, depending on uterine size) and transverse chest diameter increases
tidal volume also increases these adaptation are to help supply the fetus with necessary nutrients and oxygen |
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first trimester symptoms
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breast tingling
frequent urination (bladder compression) pelvis pressure (enlarging uterus) breathlessness (increased TV) nausea does not have an anatomic cause! |
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what is the leading cause of death during the first trimester?
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ectopic pregnancy
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where does an ectopic pregnancy usually occur?
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usually in ampulla (also isthmus, corneal, fimbrial, cervix)
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where does the majority of growth of the uterus take place?
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the top at the fundus
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what happens to the relationship between the fallopian tubes, ovaries, and round ligaments to the uterus during the second trimester?
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fallopian, round lig now insert slightly above the middle of the uterus (instead of at the fundus)
ovarian position is variable |
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urinary system second trimester
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pressure on bladder lessens as the uterus moves out of the pelvis
ureteral dilatation is up to 2 cm dilatation is R>L due to dextrorotation of uterus (sigmoid acts as a cushion) ureter is elongated and laterally displaced |
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changes to skeletal system during the second trimester
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ligaments of pelvis and extremities loosen (from hormone relaxin)
widening of the symphysis is most marked in 3rd trimester lordosis -- increased anterior convexity of the spine to keep center of gravity over the legs with an increasingly protruberant abdomen |
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GI changes during second semester
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hemorrhoids due to pelvic pressure and vasodilation
gall bladder volumes are increased and emptying is slower appendix is compressed by the uterus and moves laterally and upward (changes in mcburney's point during pregnancy) |
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second trimester symptoms
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continued breast enlargement
round ligament pain breathlessness persists constipation (mechanical obstruction by uterus) |
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uterus during the third trimester
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uterus continues to grow and almost reaches the liver
uterine wall thickness decreases to 1.5 cm uterine and ovarian veins are enormous (2.6 cm) before delivery, fetus may drop and the fundus will be lower |
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what are the main components of weight gain in pregnancy?
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fetus
extravascular fluid maternal fat stores |
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urinary system third trimester
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right ovarian vein lies obliquely over the right ureter, compressing it
as the fetal head descends into pelvis, bladder pressure returns bladder is hyperemic, engorged, the trigone is elevated, urethra lengthens |
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cardio-respiratory system (third trimester)
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subcostal angle and transverse chest diameter increase (RR goes up)
diaphragm elevates 4 cm because of uterus axis of heart is more horizontal (goes more to left) because of diaphragmatic elevation (changes axis of heart) |
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in the third trimester, what happens if a women lies on her back?
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the uterus compresses on the vena cava
dilated paravertebral vessels act as collaterals to preserve blood flow to the heart and maintain CO |
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musculoskeletal system during third trimester
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lordosis increases
marked widening of symphysis anterior abdominal wall supports uterus to keep it upright |
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cutaneous system during the third trimester
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stretch marks
increasing pigmentation of the nipples, areola, linea nigra vagina becomes hyperemic, looks bluish, increased discharge |
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rectus diastasis
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with strain on the rectus abdominis muscles and anterior ab wall, the rectus muscles can separate and the anterior uterine wall is covered only by skin, subcutaneous fat, thin fascia, and peritoneum, so uterus can sag forward
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during pregnancy, where would you find the appendix?
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probably not in RLQ...it will be elevated and the omentum will probably not be able to contain it
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after vaginal birth, what are some possible complications?
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urinary incontinence < fecal incontinence < vaginal prolapse (relative risk = 4 for 1 birth)
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which surgeries have highest success rate for fixing vaginal prolapse?
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hysterectomy (100%), while functional/plastic surgery is less successful
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what can cause vaginal prolapse?
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defects in:
CT muscles nerves |
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what closes the genital hiatus, say, when you cough?
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levator plate
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what helps hold the vagina in place?
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uterosacral ligament
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pudendal nerve location & fxn
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arises from sacral plexus (anterior rami of S2-S4)
enters perineum via lesser sciatic foramen and immediately divides into branches as it enters pudendal canal motor muscles to perineum and sensory to majority of perineal region via its branches (inferior rectal and perineal verse) |
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for women who have had one vaginal birth, how many of them had defects in their levator ani muscles and how many of those women had stress urinary incontinence?
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20% had defects and of those with defects, 71% had urinary incontinence
the number of postpartum defects increased in women with mechanical aid in delivery |
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what is some possible nerve damage of pelvic floor during vaginal delivery?
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prolonged terminal motor latencies
denervation injury by needle EMG mechanical and ischemic damage stretching can stop blood flow |
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what is the contents of the axilla?
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axillary sheath
branchial plexus axillary vessels and their branches nodes and lymphatic vessels portions of three muscles |
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what are the boundaries of the axilla?
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apex: bound by clavicle anteriorly and upper border of scapula posteriorly, and first rib medially
base: skin and fascia of the armpit anterior wall: pectoralis major and minor, clavipectoral fascia posterior wall: posterior axillary fold (teres major muscle and latissimus dorsi) and the subscapularis muscle that covers the anterior surface of the scapula medial wall: upper portion of the thoracic wall and the serratus anterior muscle, which overlies the wall lateral wall: intertubercular sulcus of the humerus |
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what is inside the axillary sheath?
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axillary artery, vein, and brachial plexus
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how is the axillary vein formed?
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via the lateral border of the teres major muscle by joining of the two brachial veins
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where does the axillary vein end?
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at the lateral border of the first rib where it is continuous with the subclavian vein
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the cephalic vein and axillary vein merge to become a tributary to which vein?
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subclavian
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what structures lie posterior to the axillary vein?
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axillary artery and brachial plexus
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the axillary artery is a continuation of which major artery?
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subclavian
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when the axillary artery reaches the interior border of the teres major muscle, what does it become?
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brachial artery
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three parts of the axillary artery
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1. extends from lateral border of the first rib to the medial border of the pectoralis minor muscle
2. lies posterior to the pectoralis minor muscle 3. extends from the lateral border of the pectoralis minor muscle to the inferior border of the teres major muscle |
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the superior thoracic artery arises from the first part of the axillary artery, where does it distribute?
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to the first and second intercostal spaces
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what are the two branches of the second part of the axillary artery?
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thoracoacromial artery
lateral thoracic artery |
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R: lateral thoracic artery and pectoralis minor
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artery arises at the lateral border of the pectoralis minor muscle and descends along the lateral border of the muscle
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what does the lateral thoracic artery supply?
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pectoral muscles
serratus anterior axillary lymph nodes lateral thoracic wall also, portion of mammary glands in femalesq |
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what spinal cord segments does the brachial plexus arise from?
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C5-T1
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name two large muscles (one front and one back) that are innervated by the brachial plexus
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latissimus dorsi
pectoralis major |
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what defines the fourth intercostal space?
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it is the space between ribs 4 and 5
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serratus anterior proximal attachments
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ribs 1-8
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which ribs are true? which are false? which are floating?
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true: 1-7
false: 8-12 floating (no attachment to sternum): 11 and 12 |
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acromion
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part of the scapula that is continuous and ateral to the clavicle
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what vertebral plan is the xiphisternal joing?
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T8
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R: breast to pectoral fascia
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breast is anterior
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boundaries of the breast
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medial: lateral edge of sternum
lateral: midaxillary line superior: rib 2 inferior: rib 6 posterior: deep fascia of the pectoralis muscle |
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what are the two heads of the pectoralis major?
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clavicular
sternocostal (attached alon gthe sternum) the jxn of these two heads is at the sternoclavicular joint |
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what vein is found in the deltopectoral groove?
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cephalic vein
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what does the medial pectoral nerve innervate?
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it pierces the pectoralis minor muscle and then enters the pectoralis major, innervating both
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attachments of the pectoralis minor
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prox: ribs 3 to 5 near their costal cartilages
dist: coracoid process of the scapula |
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attachments of subclavius muscle and its fxn
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attached to clavicle and first rib
depresses the clavicle |
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R: cephalic vein and pectoralis minor tendon
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vein is medial to tendon
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R: pectoralis minor and axillary artery
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minor crosses over second portion of the axillary artery
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what innervates the serratus anterior?
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long thoracic nerve
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what are the (bone) boundaries of the perineum?
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symphysis pubis
ischial tuberosity 2x ischiopubic rami coccyx |
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what is the distal attachment of the obturator internus?
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lesser trochanter of the femur (leaves through lesser sciatic foramen)
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how does the piriformis muscle leave the pelvis?
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greater sciatic foramen
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from what does the piriformis muscle arise?
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ventral surface of the sacrum
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what ligament does the coccygeus overlie?
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sacrospinous ligament
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what are the branches of the pudendal nerve?
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inferior anal
perineal (which gives rise to the posterior scrotal branches) dorsal nerve of penis/clitoris |
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what is contained in the male superficial perineal space?
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2x corpora cavernosa and ischiocavernosus muscles
bulb of penis (x1) or clitoris (x2) bulbospongiosus muscle(s) 2x superficial transverse perineal muscles |
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what structures are found ONLY in the male superficial perineal space?
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bulb of the penis and corpus spongiosum, which transmits the urethra
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coccygeous muscle parallels which ligament?
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sacrospinous
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what is contained in the female superficial perineal space?
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2x bulb of the vestibule
2x greater vestibular glands 2x crura of clitoris 2x superficial transverse perniues muscles shat and glans of clitoris perineal membrane |
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what nerves cause an erection?
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parasympathetics (pelvic splanchnic S2-4)
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what nerves cause emission (delivery of semen to membranous urethra?
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sympathetics from lumbar L1-L3
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what nerve causes ejaculation?
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parasympathetics (pelvic splanchnics S2-4)
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what nerves control innervation of the bladder and urination?
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vesical plexus, which is a continuation of the anterior portion of the inferior hypogastric plexus
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how (nerve-wise) is the bladder emptied?
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via parasymps facilitating relaxation of the pelvic diaphragm
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do symp or para supply the trigone and vessels of the bladder?
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symp
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proprioception from stretching as the bladder fills is carried by what?
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parasympathetics
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contents of superior mediastinum
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thymus
great vessels trachea esophagus thoracic duct |
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contents of middle mediastinum
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heart
pericardium roots of great vessels |
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contents of anterior mediastinum
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thymus, lymph, some vessels and nerves
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contents of posterior mediastinum
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thoracic aorta
thoracic duct esophagus azygos system |
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where does pain from ureteruic calculi get referred to?
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T11-T12 via visceral afferents from the ureter
the pain moves inferoanteriorly "from the loin to the groin" and may extend into the proximal anterior aspect of the thigh via the genitofemoral nerve (L1,L2) the scrotum in males and the labia majora in females |
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where is the pain of an acute rupture of the abdominal aorta felt?
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in the abdomen or back
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how might you control bleeding in the pelvis or lower limbs?
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(in thin adults and children), firmly press on anterior abdominal wall over the umbilicus , pushing the aorta against L4
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what are the three available routes for venous return when the IVC is blocked?
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superior/inferior epigastrics
thoracoepigastric vein epidural venous plexus inside the vertebral column |
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how would venous return through the epidural venous plexus work if there could be no venous return through the IVC?
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it communicates with the lumbar veins of the inferior caval system and tributaries of the azygos system of veins
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