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80 Cards in this Set
- Front
- Back
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Pelvic inlet
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Sacral promontory
Ala of sacrum Arcuate line of ilium pectineal line of pubis pubic crest pubic symphysis |
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Pelvic outlet
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coccyx
sacrotuberous ligament ischial tuberosity ischiopubic ramus pubic symphysis |
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Pelvic walls
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sacrotuberous ligament
sacrospinous ligament obturator internus piriformis |
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Pelvic diaphragm
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levator ani
(puborectalis, pubococcygeus, iliococcygeus) coccygeus |
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Urogenital triangle boundaries
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ischiopubic rami (anterolaterally)
pubic symphysis (anteriorly) line between ischial tuberosities (posteriorly) pelvic diaphragm (roof; levator ani muscles) |
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Anogenital triangle boundaries
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Sacrotuberous ligaments (posterolaterally)
coccyx (posteriorly) line between ischial tuberosities (anteriorly) Pelvic diaphragm (roof; levator ani muscles) |
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Urogenital triangle contents
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External genitalia, perineal membrane, anterior horns of ishioanal fossa
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Anogenital triangle contents
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Anal canal, anal sphincters, ischioanal fossa
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Bones of the cranial vault
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Ethmoid
Frontal Sphenoid Petrous (squamous and petrous) Occipital |
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Anterior cranial vault contents
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Crista galli
Cribiform plate Ethmoidal foraminae Orbital plate of frontal bone |
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Middle cranial vault contents
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Anterior clinoid process
Posterior clinoid process Dorsum sellae Optic canal Superior orbital fissure Foramen rotundum Foramen ovale Foramen spinosum |
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Posterior cranial vault contents
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Foramen magnum
Hypoglossal canal Jugular foramen Internal occipital protuberance Clivus Internal acoustic meatus |
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Anterior : middle cranial vault
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Medially - Pre-chiasmic groove
Laterally - Lesser wings of sphenoid bone |
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Middle : posterior cranial vault
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Medially - dorsum sellae and posterior clinoid process
Laterally - superior ridge of petrous temporal bone |
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Superior petrosal sinus
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Drains into transverse sinus from the cavernous sinus
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Inferior petrosal sinus
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Drains into the internal jugular vein from the cavernous sinus
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Greater petrosal nerve
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Branch of CNVII
Exits via foramen lacerum, through pterygoid canal into pterygopalatine fossa Synapse with pterygopalatine ganglion to supply the lacrima, nasal and palatine glands |
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Lesser petrosal nerve
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Branch of CNIX
Exits via foramen ovale Synapse with otic ganglion to supply the parotid gland |
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Abdominal cavity - boundaries
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Superior = diaphragm
Anterolateral = anterolateral abdominal wall Posterior = posterior abdominal wall Inferior = pelvic inlet |
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Abdominal regions
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Defined vertically by midclavicular line and midinguinal line
Defined horizontally by trans-pyloric plane (L1) and trans-tubercular plane (L5) Upper = L and R hypochondrium, epigastrium Middle = L and R flank, umbilical Lower = L and R inguinal / iliac region, hypogastrium |
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Structures found at the trans-pyloric plane
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1 Tip of costal cartilage 9
2 Fundus of gallbladder 3 Pyloris of stomach 4 Neck of pancreas 5 Beginning of portal vein 6 Superior mesenteric artery 7 L and R colic flexure 9 Cysterna chyli 10 End of spinal cord |
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Layers of anterolateral abdominal wall
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Midline: skin, superficial fascia, deep fascia, linea alba, transversalis fascia, extra-peritoneal fat, parietal peritoneum
Lateral: skin, superficial fascia, deep fascia, external oblique, internal oblique, transverses abdominis, transversalis fascia, extra-peritoneal fat, parietal peritoneum |
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Superficial fascia of the abdomen
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Camper's fascia (fatty); continuous with fat of the thigh
Scarpa's fascia (membranous); continuous with dartos fascia of penis and scrotum; attaches to ischiopubic ramus and posterior perineal membrane |
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Formation of the rectus sheath
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Above arcuate line - anterior layer from EO and 1/2 of IO, posterior layer from 1/2 of IO and all of TrA apnoneuroses
Below arcuate line - anterior layer from EO, IO and TrA aponeuroses, posteriorly absent Linea albea is a midline raphe formed from aponeuroses of EO, IO and TrA of both sides |
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Fascial lining of abdominal cavity
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Common lining of abdominal and pelvic cavities
Name determined by structure upon which it rests - endopelvic fascia, quadratus lumborum fascia, diaphragmatic fascia, transversalis fascia Extraperitoneal fat lies between peritoneum and fascial lining |
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Peritoneal folds of anterior abdominal wall
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Superior to umbilicus = falciform ligament
Inferior to umbilicus = urachus (medial), L and R obliterated umbilical arteries (medial), L and R inferior epigastric vessels (lateral) Lateral folds ascend towards RA, others converge on umbilicus |
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Arterial supply of anterior abdominal wall
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Superior and inferior epigastric vessels; anastamose within the rectus sheath
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Venous drainage of anterior abdominal wall
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Superficial = veins converge on umbilicus
Deep = superior epigastric vessel, para-umbilical vein, inferior epigastric vein |
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Lymphatic drainage of anterior abdominal wall
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Superficial - drain skin and superficial fascia to the axillary or inguinal lymph nodes
Deep - muscle and tissues to nodes associated with the arteries |
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Contents of the inguinal canal
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Male = spermatic cord and ilioinguinal nerve
Female = round ligament and ilioinguinal nerve |
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Layers of the inguinal canal
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1. Transversalis fascia
2. Travsersus abdominis muscle 3. Internal oblique muscle 4. External oblique aponeurosis |
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Boundaries of the inguinal canal
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Floor = inguinal ligament
Roof = internal oblique and transversus abdominis muscle Anterior = external oblique aponeurosis and internal oblique muscle Posterior = transversalis fascia and conjoint tendon |
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Spermatic cord contents
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3 arteries - cremasteric, testicular, deferential
3 nerves - ilioinguinal, genital branch of ilioinguinal, autonomic 3 fascial layers - external spermatic, cremasteric, internal spermatic 3 other - pampiniform plexus, vas deferens, testicular lymphatics |
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Coverings of the spermatic cord
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Transversalis fascia --> internal spermatic fascia
Internal oblique muscle --> cremasteric muscle and fascia External oblique aponeurosis --> external spermatic fascia |
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Hesselbach's triangle
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Rectus abdominis
Inferior epigastric artery Inguinal ligament |
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Inguinal hernias
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Direct = through Hesselbach's triangle (weakness in anterior abdominal wall); medial to inferior epigastric artery; less common; rarely enters scrotum
Indirect = through deep inguinal ring lateral to epigastric artery; most common; may extend through superficial inguinal ring into scrotum; M > F |
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Femoral hernias
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Pass through femoral ring into thigh
F > M |
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Femoral ring boundaries
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Anterior = inguinal ligament
Posterior = pectineus and fascia Lateral = femoral vein Medial = lacunar ligament |
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Diaphragm hiatuses
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"I ate 10 eggs at 12"
T8 - IVC (plus R phrenic nerve) T10 - oesophagus (plus vagal trunk) T12 - aorta (plus thoracic duct, azygos vein) |
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Posterior abdominal wall mscles
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Aponeurosis of TrA
Quadratus lumborum Psoas major Iliacus |
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Abdominal aorta
Inferior vena cava |
AA - T12 to L4
IVC - L5 to T8 |
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Abdominal cavity lymph node drainage
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Unpaired viscera --> pre-aortic nodes
Paired viscera, lower limbs, pelvis, posterior abdominal wall --> para-aortic nodes Thoracic duct --> drains to junction of L subclavian and L internal jugular veins |
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Autonomic nerves of abdominal cavity
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Sympathetic (from sympathetic trunk) = thoracic, lumbar, sacral splanchnic nerves
Parasympathetic (from S2-S4 ventral rami) = pelvic splanchnic nerves |
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Supra-renal gland blood supply
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Arterial
Superior = from inferior phrenic Middle = from abdominal aorta Inferior = from renal arteries Venous Right drains to IVC Left drains to L renal vein |
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Contents of pelvic cavity
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Coils of intestine, bladder, rectum
Male = prostate, seminal vesicles, vas deferens Females = ovaries, uterine tubes, uterus, upper vagina |
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Superficial fascia of perineum (boundaries)
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Continuous with Scarpa's fascia
Ends posteriorly at the perineal membrane, attaches laterally with ischiopubic ramus and lies deep to skin of scrotum and skin of penis |
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Muscles of urogenital triangle
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Ischiocavernosus muscle
Bulbospongiosus muscle Superficial transverse perineal muscle Deep transverse perineal muscle |
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Arterial supply to pelvis and perineum
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Internal iliac artery supplies pelvic viscera, perineum, gluteal area and has branches to bladder, uterus, vagina, prostate and vas deferens
Internal pudendal artery is a branch of the internal iliac artery and rovides arterial supply to the perineum, as well as erectile tissue The testicular artery (or ovarian) artery supplies the gonads |
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Venous drainage of pelvis and perineum
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Valveless venous plexus drains the pelvic viscera; this drains to internal iliac veins with some drainage to internal vertebral plexus via sacral veins
Exception is drainage of the rectum which is via the interior mesenteric vein --> portal vein |
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Lymphatics of pelvis
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Organs drain to nearby vessel nodes
Exception is ovaries, uterine tubes and fundus of uterus drain with ovarian vessels to para-aortic nodes |
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Lymphatics of perineum
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Skin plus lower urethra, vagina and anal canal drain to superficial inguinal nodes. Most deep parts of perineum drain to internal iliac nodes.
Exception is testes and epididymis that drain to para-aortic nodes by following testicular vessels |
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Descent of the tests
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- Gubernaculum guides descent of the testes through the abdominal wall (inguinal canal) into scrotum
- Processus vaginalis (a downward extension of the peritoneum) is drawn from the gubernaculum - Part of the processus vaginalis in spermatic cord later obliterates leaving the tunica vaginalis (visceral and parietal layer) |
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Dartos muscle of scrotum
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Smooth muscle, sympathetic control
Contracts in response to cold and brings testes closer to body Relaxes relaxes in response to warmth |
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Cremaster muscle
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Skeletal muscle, lifts testes
Protective reflex active in very young Stroke medial upper thigh --> reflex retraction of testes (L1, L2; genitofemoral nerve) |
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Arterial supply and venous drainage of the testes
Nerve supply to testes |
Testicular artery from abdominal aorta supplies testes
Artery of ductus deferens from internal iliac supplies the ductus deferens and provides collateral supply to the testes Testicular vein is from the pampiniform plexus of the spermatic cord Right --> IVC Left --> L renal vein T10 nerve supply (sympathetic) |
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Structure of prostate
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Prostate has 3 lobes - isthmus (anterior to urethra), median, posterior
Ejaculatory duct formed from seminal vesicles and ductus deferens Open into seminal colliculus of prostate (midline) Prostatic sinus has openings of prostate gland |
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Arterial supply and venous drainage of prostate
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Arterial = branches of internal iliac artery
Venous = prostatic venous plexus --> drains to internal iliac vein but also partly to vertebral plexus Lymphatic drainage = mainly to internal and external iliac nodes |
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Ligaments of the penis
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Fundiform ligament from linea alba; more superficial
Suspensory ligament from pubic symphysis; cut in lengthening procedure |
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Erectile tissue of penis
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Corpus spongiosum - starts at bulb of penis and enlarges distally as the glans penis; transmits spongy urethra
Corpus cavernosum - starts at L and R crus (attached to ischiopubic ramus) to continue as shaft |
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Muscles of penis
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Bulbospongiosus muscle - covers bulb of penis; anterior fibres aid erection by compressing deep dorsal vein
Ischiocavernosus musle - covers crura; forces blood from crura into corpus cavernosum |
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Arterial supply to penis
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Arterial is internal pudendal artery into the corpora cavernosa
Venous drainage is deep dorsal vein of penis into prostatic venous plexus |
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Nerve supply to male genitals
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Sensory via pudendal nerve but also ilioinguial / genitofemoral nerve which supplies anterior 1/3 of scrotum
Motor via pudendal nerve |
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Mullerian duct
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Paramesonephric duct
Degenerates in males Forms fallopian tubes, uterus, cervix and upper 2/3 vagina in females |
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Wolffian duct
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Mesonephric duct
Will degenerate in the absence of testosterone Forms epididymis, vas deferens and seminal vescicle in males |
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Broad ligament (components)
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Mesosalpinx (above)
Mesovarium (lateral) Mesometrium (inferior) Ovarian ligament attaches ovary to uterus Suspenory ligament attaches ovary to pelvic wall |
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Fallopian tubes (sections)
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Infundibulum
Ampulla Isthmus Uterine (intramural) |
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Anteversion
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Perpendicular angle between the cervix and vagina
Anteflexion = angle between the cervix and body of uterus |
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Uterine support
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Passive = pubocervical ligament, uterosacral ligament, transverse cervical ligament
Active via the pelvic diaphragm (levator ani) |
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Blood supply and venous drainage to female reproductive organs
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Internal iliac artery --> uterine artery, vaginal artery
Ovarian artery from the abdominal aorta (travels in suspensory ligament of ovary) Venous drainage follows arteries (except erectile tissue, via dorsal vein of clitoris to vesical venous plexus of pelvis) R ovarian vein into IVC L ovarian vein to L renal vein |
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Innervation of female reproductive organs
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Body of uterus above pelvic pain line --> pain fibres pass with sympathetic nerves
Cervix is below pelvic pain line --> fibres travel with parasympathetic nerves |
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Renal fascia
Perinephric fat Paranephric fat |
Renal fascia - surrounds each kidney and suprarenal gland, with thin fascia between suprarenal gland and kidney
Perinephric fat - Immediately surrounds each kidney and extends into the renal sinus Paranephric fat - Lies superficial to the renal fascia and is thickest posteriorly and laterally |
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Renal hilum (structures)
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Anterior to posterior:
Renal vein Renal artery Renal pelvis (plus nerves and lymphatics) |
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Relationships of R kidney
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Superior - suprarenal gland
Anterior - liver Medial - descending duodenum Inferior - right colonic flexure (lateral), jejunum (medial) |
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Relationships of L kidney
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Superior - suprarenal gland, stomach and spleen
Anterior - pancreas Laterally - descending coIon Inferior - jejunum (media) |
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Position of L and R kidneys
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R kidney T12
L kidney T11, T12 Both are retroperitoneal |
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Course of ureters in males and females
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Abdominal - retroperitoneal, on psoas major
Pelvis - extraperitoneal from pelvic brim posterolaterally then turns medial / anterior at ischial spine towards bladder "water under the bridge" - in females bridge is uterine artery, males is ductus deferens |
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Constriction points of ureters
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1. pelviureteric junction
2. pelvic brim 3. entrance to bladder |
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Relations of bladder in female
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Anterior - retropubic space and pubic bone
Superior - coils of intestine and body of uterus Posterior - cervic of uterus and vagina Inferolateral - lavator ani muscle and obturator internus |
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Relations of bladder in male
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Anterior - retropubic space and pubic bone
Superior - coils of intestines Posterior - rectum, ductus deferens, seminal vesicles Inferior - prostate Inferolateral - levator ani muscle and obturator internus |
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Parts of male urethra
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Pre-prostatic --> prostatic --> membranous --> spongy
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