Clinical Anatomy for OB/GYN

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A creative commons 3.0 pack of abstruse anatomy questions for OB/GYNs

What are striae?

Rupture of connective tissue fascicles, perpendicular to Langer's lines

Where does a Spigelian hernia arise?

the junction of the linea semilunaris and arcuate line

What is the origin of the external oblique?

lower 8 ribs

What is the insertion of the external oblique?

insertion iliac crest,anterior superior iliac spine (pubic tubercle and crest by way of apon. of external oblique)

What is the innervation of the external oblique?

innervation T7 to 12

What is the origin of the internal oblique?

thoracolumbar fascia, iliac crest, lat 2/3 of inguinal ligament

What is the insertion of the internal oblique?

inferior border of last three ribs, linea alba, pubic crest

What is the innervation of the internal oblique?

T7 to 12

What is the origin of the transversus abdominis?

inner aspect of 6 inf. costal cart. iliac crest, lateral 1/3 inguinal lig.

What is the insertion of the transversus abdominis?

linea alba, pubic crest

What is the innervation of the transversus abdominis?

T7 to T12

What is the falx inguinalis?

arcing inferior free edge of transversus abdominus

What is the origin of the rectus abdominis?

superior pubic ramus, ligaments

What is the insertion of the rectus abdomens?

surface of ribs 5 to 7

What is the innervation of the rectus abdominis?

T7 to 12

What is the origin of the pyramidalis?

pubic crest

What is the insertion of the pyramidalis?

linea alba anterior to rectus muscles, used to find midline

What is the innervation of the pyramidalis?

T12

Where does the transversalis fascia arise?

inner aspect of costal margin, thoracolumbar fascia, iliac crest.

Where does the transversalis fascia insert?

linea alba, pubic crest. It has parietal and visceral component (endopelvic fascia) becomes inferior fascia of diaphragm

What are the boundaries of the inguinal triangle of Hesselbach?

inferior epigastric artery, linea semilunaris, inguinal ligament, it is site of direct hernia

What are the parts to the bony pelvis?

1. Sacrum 2. Coccyx 3. Ilium 4. Ischium 5. Pubis

A woman with a platypetelloid pelvis delivers a large baby. The next day she has severe back pain. Dx?

fractured coccyx

What is the ileopectineal line?

junction between ilium & pubis

What is the iliac fossa?

anterior concavity of ilium, covered by iliacus m.

What is Cooper's ligament?

A condensation of fascia along pectinate line anteriorly used in Burch procedures

What is the function of the ischial tuberosity?

what we sit on

Where does the inferior fascia of the urogenital diaphragm insert?

pubic ramus

What are the contents of the greater sciatic foramen?

piriformis, superior gluteal nn, sciatic n, n. of quadratus femoris, inferior gluteal n, inferior gluteal vessels, post. cutaneous n. nn of obturator internus, internal pudendal n/a /v)

What is formed by the superior & inferior pubic rami?

obturator foramen

What 3 structures attach to the pubic tubercle?

inguinal ligament, rectus abdominis, pyramidalis

What are the boundaries of the pelvic inlet

sacral promontory, arcuate line, pectineal line, pubic crest, upper margin of symphysis

What are the boundaries of the pelvic outlet?

coccyx, symphysis, ischial tuberosities

What muscles make up the lateral pelvic sidewall above the arcus tendineus?

piriformis, obtuator internus, iliopsoas

What is the orgin of the piriformis?

sacrum, (overlain by the sacral plexus coccygeus associate with the coccyx)

What is the insertion of the piriformis?

greater trochanter

What does the piriformis do?

lateral rotation, abduction of thigh, bed for sacral plexus

What is the innervation of the piriformis?

innervation S1 to S2

What is the origin of the obturator internus?

superior and inferior pubic rami exits lesser foramena

What is the insertion of the obturator internus?

inserts on greater trochanter

What does the obturator internus do?

lateral rotation of thigh

What is the innervation of the obturator internus muscle?

L4 to S1 obturator internus n.

What is the origin of the iliopsoas?

psoas lateral margin of lumbar vertebrae, iliacus iliac fossa

What is the insertion of the iliopsoas?

lesser trochanter of femur

What is the function of the iliopsoas muscle?

action flexes thigh, stab. spine

What is the innervation of the iliopsoas muscle?

psoas L1 to 3 iliacus L2 to 3

What structures rest on the psoas muscle?

overlain by tendon of psoas minor and genitofemoral nerve

What is the origin of the levator ani?

tendinous arch from pubis to ischial spine

What is the insertion of the levator ani?

insertion central tendon, wall of anal canal (puborectalis), wall of vagina (pubovaginalis), anococcygeal lig, coccyx (pubococcygeus)

What is the function of the levator ani?

support, bm mechanism, supports fetal head

What is the innervation of the levator ani?

S3 to S4 via inferior rectal n

What is the origin of the coccygeus

ischial spine & sacrospinus ligament

What is the insertion of the coccygeus?

lateral margin of 5th sacral vertebra and coccyx

What is the function of the coccygeus?

supports coccyx and pulls it ant.

What is the innervation of the coccygeus?

S4 to S5

What are 2 muscles of the urogenital diaphragm?

deep transverse perineal and sphincter urethrae complex

What is the origin insertion, action and innervation of the deep transverse perineal muscle?

origin: med. aspect of ischiopubic rami insertion: lower vaginal wall
action: steadies central tendon innervation S2 to S4 perineal n

What is the origin insertion, action, and innervation of the sphincter urethrae?

origin: medial aspect of ischiopubic rami insertion: urethra and vagina
action: compresses urethra innervation S2 to S4

What makes up the lateral walls of pelvis below the arcus tendineus?

levator ani

Name the 3 types of peritoneal fascia.

1. parietal covers muscles continuation of transversalis fascia includes arcus tendineus. 2. diaphragmatic : covers urogenital diaphragm Has two layers (internal and external) Internal or superior layer is strongest.
3.endopelvic fascia covers the three tubular structures

What is the hiatus of Schwalbe?

space between the levators and obturator fascia that may herniate to ischiorectal fossae/suprategmental space.

What is the boundary of the perineum?

symphysis, coccyx, inferior pubic ramus, ischial rami, ischial tuberosities, sacrotuberous ligaments. (External to the levators)

What is the line of Hart?

mucocutaneous junction found in the vagina

Name the 5 muscles that insert on the perineal body.

bulbocavernosus x2,
superficial transverse perineal x 2
deep transverse perineal x2,
levator ani,
external sphincter

Describe the path of the pudendal(Alcock's) canal.

runs from post ischirectal fossa at lesser sciatic foramen at edge of urogential diaphragm

What supports the lower 1/3 of the vagina?

arcus tendineus, UGD, perineal body

What supports the middle 1/3 of the vagina?

urogential diaphragm

What supports the upper 1/3 of the vagina?

cardinal and uterosacral ligaments

Name the four arteries that supply the vagina.

Vaginal artery, vaginal branch from uterine a, middle rectal, internal pudendal

What are the azygos arteries of the vagina?

midline fusion of vaginal arteries, analogous to inferior ves aa in the male

What nodes would be positive soonest in a patient with vaginal cancer involving the upper 1/3 of the vagina?

iliac nodes

What are the three layers to the vagina?

Mucosa, mucularis (inner circular & outer longitudinal), adventita

Describe the innervation of the upper vagina.

uterovaginal plexus

Describe the innervation of the distal vagina.

Pudedal nerve (S2 to S4)

What is the portio vaginalis?

The portion of the cerix in the vagina

Name three clinical conditions whre you may find cervical ectropion.

childhood, pregnancy, OCP use

Describe the transformation zone.

The tissue of the cervix between the outer ring of the old squamocolumar junction the the current SCJ

Where do most squamous cell cancers arise in the cervix?

squamocoumnar junction

Why does the abdominal wall have no deep fascia?

Allows GI tract to expand. No deep fascia only Campers/Scarpas and muscles/aponeurosis

What structure is found in the median umbilical fold?

Urachus (all that is left from the ventral mesentery of the hind gut)

What is the contents of the medial umbilical ligament?

obliterated umbilical vessels from the hypogastric system

What is the contents of the lateral umbilical fold?

Inferior epigastric vessels

What is contained within the falciform ligament?

ligamemtum teres and obliterated left umbilical vein

How can you diagnose a direct hernia?

Occurs via internal ring , controlled by pressure 1/2 inch above femoral pulse that closes canal

How can you diagnose a direct hernia?

Through the post. wall of inguinal canal, medial to above point. Not controlled by occluding the inguinal canal.

What is the embryonic origin of the bladder dome?

ventral part of cloaca below the urorectal fold.

What is the relationship of the deep inguinal ring and the epigastric artery?

The artery is the medial border of the ring

What structes can be found in the canal of Nuck?

Round ligament, ilioinguinal nerve.

What is the blood supply to the bladder?

Blood from superior vesicular a, middle vesicular artery, inferior ves artery, middle hemorrhiodas artery, uterine, vaginal a..

On D&C a probe perforates the middle 1/3 of the vagina anteriorly. In what part of the bladder would it be found?

Trigone

What nerve carries voluntary signals to the bladder?

None

What nerve controls the urethral sphincter?

Pudendal S2 to S4

What is the muscle arrangement of the urethra?

inner long & outer circular layer

What is the blood supply to the urethra?

vesical and vaginal art.

What are the three layers to the ovary?

cortex, central medulla, rete ovarii aka hilum)

What is the tunica albiginea?

Outer cortex of ovary

What is the ovarian fossa?

space between iliac vessels and ureter

What is the arrangement of muscles on the fallopian tube?

inner circ & outer longitudinal

Where does the tube refer pain?

T12

When does the Mullerian tissue fuse?

10 weeks

A woman with a bicornuate uterus presents to your clinic. This defect represents...

Failure of fusion of the mullerian system

Unilateral atresia of the mullerian system results in what type of abnormality?

Unicornuate uterus

Bilateral attresia of the mullerian system results in what syndrome?

rokitansky kuster hauser

Failure of central degeneration of the fused mullerian ducts results in what types of uterine anomalies?

arcuate, septum, didelphus, didelphus with vag septum

What are the two layers of the endometrium?

Functionalis, basalis

What is the region of the uterus above the tubal ostia named?

Fundus

A patient presents with a cervix located on the anterior vaginal wall with the uterus angling posteriorly. This is called ...

Retroflexion. Flexion refers to the angle between the corpus and cervis (with in the uterus)

What does the term version describe?

uterus to vagina angle

The name of the stitch placed throught the broad ligament to control post=partum hemorrhage is the ....

O'Leary

What is the policeman of the abdomen?

The omentum (Latin for apron)

How many layers to the momentum?

4 layers

To what does the omentum connect?

antimesenteric side of colon to greater curvature of stomach.

What is the foramen of Winslow?

connects the greater and lesser sac

What is the greater sac?

The peritoneum

What are the boundaries to the foramen of Winslow?

Anterior: lesser omentum with hepatic art., hepatic portal v, CBD posterior: IVC, right crus of diaphragm superior: cuadate lobe of the liver inferior" duodenum

What forms the lesser sac?

an invagination of the right side of the dorsal mesentery of the stomach

What are the boundaries of the lesser sac?

Anterior liver Superior diaphragm Posterior coronary Ligament Inferior gastrocolic ligament of greater omentum Left spleen Pouch of Morrison on right.

You are staging a patient for ovarian cancer. An accidental enterotomy is made somewhere in the small bowel. How can you tell duodenum from jejunum?

Duodenum has thicker walls, greater diameter, thinner mesentery and less fat, longer arcades with fewer branches.

What are the characteristics of a Meckel's diverticulum

Occurs in 2%, 2x males:females, 2 feet from ileocecal valve, 2 inches long. Remnant of vitello intestinal duct

Name two arteries that provide important collateral circulation to the large bowel.

Arch of Riolan, marginal artery of Drummond

What is Sudek's critical point?

A watershed connection between the descending colon and rectum.

You are resecting extensive peritoneal endometriosis. Your dissection extends down the sigmoid to the rectum. At what point does the rectum become retroperitoneal?

at level of pouch of Douglas

What is the pectinate line?

The transition from columnar epithelium to stratified squamous in the anus

What is the arrangement of the muscles in the ureter?

inner long. and outer circular (reverse)

What is the vascular plexus around the ureter called?

Auerbach's plexus

A renal stone in the upper collecting system refers pain to what dermatome?

upper T12 to L1 back

A renal stone in the abdominal portion of the ureter refers pain to what dermatome?

abdominal L1 to L2 refer to inguinal & pubic region

A renal stone in the pelvic ureter refers pain to what region of the pelvis?

post. thigh. (S2-S4)

How many vertebrae fuse to form the sacrum?

5 fused vertebrae

Describe the sacral foramima.

4 posterior foramina (sacral n), 4 anterior foramina (sacral n. & lateral sacral vessels)

How many vertebrae fuse to form the coccyx?

coccyx 4 fused vertebrae

What is usually the first artery divided during abdominal hysterectomy?

Artery of Sampson (contained within the round ligament)

Describe the path of the round ligament.

Inserts in canal of Nuck deep inguinal ring, runs around inf epigastric vessels becomes extraperitoneal and crosses the obliterated hypogastric a. to insert in labia majora

What ligament primarily holds the cervix and vagina over the levator plate?

Cardinal/uterosacral complex

What is the superior boundary of pouch of Douglas?

Insertion of the uterosacral ligaments

What nerves travel in the uterosacral ligaments?

parasympathetic and sympathetic fibers from the hypogastric plexus

What structure suspends the urethra from the pubic bone?

Pubourethral ligament

You are doing a C section. You have divided the rectus muscles and entered the peritoneum. As you extend your incision toward the bladder, you divide thick connective tissue bands overlaying the peritoneum. What are they?

Transversalis fascia

What is the difference between a pertoneal fold and a peritoneal ligament?

A ligament is a double layer of peritoneum covering a neurovascular structure. A fold appears over a single tubular structure (obliterated?) blood vessel or ureter

Name the major branches of the inferior mesenteric artery.

left colic (transv. to descending colon) sigmoid, superior rectal.

What are the 5 branches of the external iliac artery?

superficial epigastric, external pudendal, superficial circumflex iliac, inferior epigastric, deep circumflex iliac of sciatic foramen.

You are doing a Burch procedure and dissect out just a little to far. Your field fills with venous blood. What vessel was injured?

Plexus of Santorini

You are doing a Burch procedure and dissect just a little to far laterally. You encounter a brisk arterial bleeder. What vessel have you injured?

Aberrant obturator (in 35% the pubic branch of inferior epigastric is large and replaces obturator)

What are the branches of the internal pudendal artery?

inferior hemorrhoidoal, perineal, clitoral.

Is the pudendal artery medial or lateral to the nerve?

lateral

In what structure does the middle hemorrhoidal artery appear?

lateral rectal ligament

What 12 nerves make up the lumbosacral plexus?

Iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, femaoral, obturator, superior gluteal, inferior gluteal, posterior femoral cutaneous, sciatic, pudendal

What nerve innervates the skin of iliac crest and pubis?

Iliohypogastric L1

What nerve penetrates external oblique 1 to 2 cm superomedial to superficial ring?

Iliohypogastric L1 sensory

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