body plan
trophoblastic
tube with in a tube
coelom(true body cavity)
segmentation
symmetry
tube with in a tube
coelom(true body cavity)
segmentation
symmetry
trophoblastic germ layer
ectoderm
mesoderm
endoderm
mesoderm
endoderm
coleom
cavity lined with mesoderm during dev'l
entercoelimate
entercoelimate
segmentation
repetition of body parts
specialization of body parts
specialization of body parts
symmetry
bilateral-mirror image
dorsal cavity
cranial
spinal
spinal
ventral cavity
thoracic-pleural, mediastinal(pericardial)
abdomniopelvid- abdominal, pelvic
abdomniopelvid- abdominal, pelvic
coelom division
parietal and visceral
coelom membranes
pleura
pericardium
peritoneum
mesenteries
pericardium
peritoneum
mesenteries
ventral mesentery
disappears
dorsal mesenteries
mesoesophagus-becomes part of diaphragm
mesogaster- becomes ligaments
mesentry-> mesentery proper
mesocolon- transverse and sigmoid
mesogaster- becomes ligaments
mesentry-> mesentery proper
mesocolon- transverse and sigmoid
pleuroperitoneal membrane
sep pleural and peritoneal cavities
duses to form portion of diaphragm
duses to form portion of diaphragm
pleuropericardial membrane
separates pericardial cavity from pleural cavity
diaphragm
-septum transversarium->central tendon
-mesoesophagus
-pleuroperitoneal membrane
-striated muscle from body wall
-mesoesophagus
-pleuroperitoneal membrane
-striated muscle from body wall
branches from aortic arch
-brachiocephalic-rt common carotid and st subclavian
-left subclavian
-left common carotid
-left subclavian
-left common carotid
branches from descending aorta
paired segmental
paired non-segmental
unpaired non-segmental
paired non-segmental
unpaired non-segmental
paired segmental
intercostal(posterior)
lumbars
lumbars
paired non-segmental
phrenic
renal
gonadal
renal
gonadal
unpaired non-segmental
celiac trunk
superior mesenteric
inferior mesenteric
esophageal
bronchial
superior mesenteric
inferior mesenteric
esophageal
bronchial
lines of thorax
midsternal
parasternal
midclavicular
anterior axillary
midaxillary
parasternal
midclavicular
anterior axillary
midaxillary
breast components
glandular-ducts and mammary
fatty tissue-adipose and connective
fatty tissue-adipose and connective
breast location
superior mid surface of chest wall
breast fx
auxillary reproductive organs
female: lactiferous
males: undeveloped
female: lactiferous
males: undeveloped
ductal system of breasr
glands form lobules
lobules form lobes (15-25)
lactiferous-sinsuses(ampullae)
-each have individual opening to nipple
lobules form lobes (15-25)
lactiferous-sinsuses(ampullae)
-each have individual opening to nipple
fatty tissue of breast
80-85%
between lobes
gives bulk and shape to breast
between lobes
gives bulk and shape to breast
areola
-4th intercostal interspace
-pigmented skin
-sebaceous glands-protection
-circualr smooth mm-contraction when stimulated
-pigmented skin
-sebaceous glands-protection
-circualr smooth mm-contraction when stimulated
gynocomastia
enlargement of male breast that is caused by a high ratio of estradiol to testosterone; major concern with patient is psychological problems and potential for breast cancer
epigastric
lying on or over the stomach
hypochondriac
upper right and left regions beneath the ribs
thorax communication
neck=superior thoracic aperature(inlet)
ab=inferior thoracic aperature(outlet)
pectoral=anterior chest wall-attachment for mm
ab=inferior thoracic aperature(outlet)
pectoral=anterior chest wall-attachment for mm
thoracic outlet syndrome vs anatomical thoracic outlet
STA vs ITA
TOS
arm numbness
brachial plexus entrapment
STA
brachial plexus entrapment
STA
thoracic landmarks
vertebral spinous processes
sternum: jugular notch, sternoclavicular joint, sternal angle(of Louis), xiphoid process(infrasternal angle)
ribs(true, false, floating)
pectoral girdle-clavicles, midclavicular line, scapula
sternum: jugular notch, sternoclavicular joint, sternal angle(of Louis), xiphoid process(infrasternal angle)
ribs(true, false, floating)
pectoral girdle-clavicles, midclavicular line, scapula
pec minor
O: ribs 3-5
I: coracoid
A: depresses and rotates scapula
elevates ribs forced inspiration
N: med pectoral N (C6-8)
I: coracoid
A: depresses and rotates scapula
elevates ribs forced inspiration
N: med pectoral N (C6-8)
SCM
O: manubrium, prox clavicle
I: mastoid, sup nuchal line
A: ant neck flex, lat flex and contra rot of head
N: CN XI, C2-4)
I: mastoid, sup nuchal line
A: ant neck flex, lat flex and contra rot of head
N: CN XI, C2-4)
scalenes
O:TP C3-7
I: ribs 1-3
A: accessory to inspiration, elevation of ribs
N: C4-8
I: ribs 1-3
A: accessory to inspiration, elevation of ribs
N: C4-8
intrinsic muscles of inspiration
external and internal intercostal
transverse thoracis, subcostalis, innermost intercostal, levator costorum
N: intercostal Nn
transverse thoracis, subcostalis, innermost intercostal, levator costorum
N: intercostal Nn
diaphragm regions
costal
sternal
crural
central tendon
sternal
crural
central tendon
diaphragm foramina
hiatus: aortic, esophageal, caval
diaphragm Action
radial arrangement pulls inferior increases thoracic volume for inspiration
thoracic vasculatrue
neurovascular bundle: post intercostal A/V/N
-posterior intercostal
-internal thoracic-anterior intercostals, superior epigastric
-highest intercostal- from costocervical trunk
-posterior intercostal
-internal thoracic-anterior intercostals, superior epigastric
-highest intercostal- from costocervical trunk
mechanical respiration
costal
diaphragmatic
diaphragmatic
bucket handle effect
increase transverse diameter
-ribs move up and outward
-ribs move up and outward
pump handle effect
increase A- diameter
forced inspiration
addition of extrinsic respiratory mm
pec major/minor
SCM, scalenes (Runner's Posture)
pec major/minor
SCM, scalenes (Runner's Posture)
if bedridden with respiratory prob
should be propped up to allow gravity to aid respiration
costal vs diaphragmatic
costal: female, thin
diaphragmatic: male, heavy, children, elderly
other factors: age, sex, body type, profession, health, clothing
diaphragmatic: male, heavy, children, elderly
other factors: age, sex, body type, profession, health, clothing
anterior mediastinum
inferior thymus
ligaments
connective tissue
potential space
ligaments
connective tissue
potential space
middle mediastinum
pericardial cavity-heart
phrenic nerve
lung roots
pulmonary trunk and R/L pulm A
-L/R sup/inf pulm V
-sup/inf vena cava
-arch of azygos
ascending aorta
lymph nodes
phrenic nerve
lung roots
pulmonary trunk and R/L pulm A
-L/R sup/inf pulm V
-sup/inf vena cava
-arch of azygos
ascending aorta
lymph nodes
posterior mediastinum
esophagus
thoracic ducts
inferior vena cava
azygos and hemiazygos veins
sympathetic chains
vagus nerves
thoracic ducts
inferior vena cava
azygos and hemiazygos veins
sympathetic chains
vagus nerves
superior mediastinum
superior part of thymus
aortic arch and great vessels
trachea
mainstem bronchi
esophagus
superior vencava
autonomic to heart and lungs
aortic arch and great vessels
trachea
mainstem bronchi
esophagus
superior vencava
autonomic to heart and lungs
pleural regions
costal
diaphragmatic
mediastinal
cervical(cupula)
diaphragmatic
mediastinal
cervical(cupula)
pleural recesses
rt and lft costodiaphragmatic
costomediastinal(left side)
costomediastinal(left side)
pleural lines of reflection
-anterior border rt and left
left side-cardiac notch
-inferior at rib 12
-posterior at cupula to T12
left side-cardiac notch
-inferior at rib 12
-posterior at cupula to T12
pleural mesentery
pulmonary ligament
lung root (radix) structures
main stem bronchi
pulmonary artery
pulmonary veins
bronchial lymphatics
pulmonary artery
pulmonary veins
bronchial lymphatics
lingula
of left lung formed by cardiac incisure
hilum
"a small thing, a trifle, a little bit of nothing"
[-root of lung]
[-root of lung]
lung fissures
oblique -rt adn lft
horizontal- rt only
horizontal- rt only
lung divisions
trachea to primary-> carina
primary bronchi-> rt and left
secondary bronchi->lobes rt(3) and lft(2)
tertiary->segments rt(8) and lft(8-10)
from tertiary->terminal->respiratory->alveoli
primary bronchi-> rt and left
secondary bronchi->lobes rt(3) and lft(2)
tertiary->segments rt(8) and lft(8-10)
from tertiary->terminal->respiratory->alveoli
middle mediastinum boundaries
-R/L pleural cavities
-diaphragm
-ant and post portions of pericardium
-super of R/L pulmonary A (adventitia)
-diaphragm
-ant and post portions of pericardium
-super of R/L pulmonary A (adventitia)
other heart terms
venous cross
ansa("foot") cervicalis
ansa("foot") cervicalis
pericaridal cavity
heart
roots of great vessels
-aorta
-pulm trunk
-vena cavae
-pulm V
roots of great vessels
-aorta
-pulm trunk
-vena cavae
-pulm V
serosa layers
parietal(1)-lines
visceral(1)-covers
mesentery(2) supports
visceral(1)-covers
mesentery(2) supports
parietal pericardium
outer layer: fibrous-adventitia
inner: mesothelium
-attached to central tendon and sternal periosteum-sternopericardial ligement
-contiunous w adventitia of great vessels
inner: mesothelium
-attached to central tendon and sternal periosteum-sternopericardial ligement
-contiunous w adventitia of great vessels
parietal pericardium fx
prevents transient over distention
-will stretch over time ex: congestive heart failure
-will stretch over time ex: congestive heart failure
visceral pericardium
outer-mesothelium
inner-thin fibrous-intimate to heart
inner-thin fibrous-intimate to heart
pericardial fluid secreted by
mesothelium
pericardial reflections
oblique sinus-post to heart
transverse sinus-behind ascending aorta and pulm trunk
transverse sinus-behind ascending aorta and pulm trunk
right coronary
-from rt aortic sinus(of Valsalva)
-under rt auricular through sulcus(ant)
-under rt auricular through sulcus(ant)
rt coronary branches
nodal
rt marginal
post interventrical/ rt post descending
rt marginal
post interventrical/ rt post descending
rt coronary supplies
atrium
SA node
post 1/3 of interventricular septum
AV node
rt branch of AV bundle
anastomoses w circumflex
SA node
post 1/3 of interventricular septum
AV node
rt branch of AV bundle
anastomoses w circumflex
left coronary
from left sinsus
-bifurcates to left anterior descending/anterior interventricular
-bifurcates to left anterior descending/anterior interventricular
anterior interventricular supplies
ant lft&rt ventricle
ant 2/3 pf interventricular septum
lft AV bundle (of His)
anastomoses with PIA
ant 2/3 pf interventricular septum
lft AV bundle (of His)
anastomoses with PIA
coronary sinus
-most venous return
in post sulcus
opens to rt atrium
in post sulcus
opens to rt atrium
coronary sinus tributaries
great cardiac
middle cardiac
small(least) cardiac
oblique (marshall's)
middle cardiac
small(least) cardiac
oblique (marshall's)
anterior cardiac
one of several small veins
open into rt atrium
open into rt atrium
least cardiac (thesbian) (venae cordis minimae)
drain endocardium
and innermost myocardium
drain mostly to rt atria and ventricle
-valveless, very tiny
and innermost myocardium
drain mostly to rt atria and ventricle
-valveless, very tiny
endocardium
inner lining of heart chambers
valve cusps formed by double layer of CT strpoma
valve cusps formed by double layer of CT strpoma
cardiac muscle
3 layers: layers oriented perpendicular, arranged spirally
most in ventricular walls
originate from annulus fibrosis
do not cross coronary plane
most in ventricular walls
originate from annulus fibrosis
do not cross coronary plane
conducting system
SA node
interatrial syncytium
AV node
AV bundle (of His)
bundle branches (purkinje fibers)
interatrial syncytium
AV node
AV bundle (of His)
bundle branches (purkinje fibers)
annulus fibrosis
fibrosus ring
DFCT
in AV plane
skeleton of heart
demarcates coronary sulcus
origin of myocardium
surrounds and supports valve openings
CT stroma of L/R AV valves and semilunar valves- cont w rings
only aV bundle passes thru
DFCT
in AV plane
skeleton of heart
demarcates coronary sulcus
origin of myocardium
surrounds and supports valve openings
CT stroma of L/R AV valves and semilunar valves- cont w rings
only aV bundle passes thru
valves
double folding of endothelium(endocardium)
stroma of CT
stroma of CT
stroma
the supporting tissue of an organ (as opposed to parenchyma)
other heart structures
chordae tendinae(prevent regurgitation)
papillary mm
papillary mm
diastole
relaxation of ventricles
systole
contraction
inflammation of cusps
scars may form along margins
valve stenosis
narrowing
incompetency
valces can't close completely
Atrioventricular valves (AV)
rt-tricuspid(ant, post, septal cusps)
lft-bicuspid/mitrial (ant/post cusps)
lft-bicuspid/mitrial (ant/post cusps)
semilunar valves
aortic
pulmonary
3 cusps
close by reflexive turbulence
pulmonary
3 cusps
close by reflexive turbulence
heart sounds
2nd intercostal interspace
-Rt-pulm semilunar
-Lft-aortic semilunar
5th intercostal space
-rt-tricuspid
-lft(mid-clav(apex of heart))- bicuspid
-Rt-pulm semilunar
-Lft-aortic semilunar
5th intercostal space
-rt-tricuspid
-lft(mid-clav(apex of heart))- bicuspid
fetal circulation
oxygenation at placenta
fetal shunts
-foramen ovale-fossa ovalis
-ductus arteriosus-ligamentum arteriosus
-ductus venosus-ligamentum teres hepatica(umbilical veins)
-umbilical arteries->medial umb fold/umb ligaments
-ductus arteriosus-ligamentum arteriosus
-ductus venosus-ligamentum teres hepatica(umbilical veins)
-umbilical arteries->medial umb fold/umb ligaments
ductus arteriosus
a blood vessel in a fetus that bypasses pulmonary circulation by connecting the pulmonary artery directly to the ascending aorta
ductus venosus
the fetal structure that allows most of the blood to bypass the liver and to flow from the umbilical vein to the vena cava
foramen ovale
Connects the left and right atria, allowing blood to flow directly from the right to the left side of the fetal heart
external abdominal landmarks
xiphoid process
costal margins
iliac crest
ASIS
pubic tubercle and crest
inguinal ligament
linea semilunaris and linea alba
tendinous intersections
umbilicus
costal margins
iliac crest
ASIS
pubic tubercle and crest
inguinal ligament
linea semilunaris and linea alba
tendinous intersections
umbilicus
quadrants
vertically and horizontally dividing through umbilicus
-RUQ, LUQ, RLQ, LLQ
[McBurney's pt-thumb length from umbilicus towards ASIS]
-RUQ, LUQ, RLQ, LLQ
[McBurney's pt-thumb length from umbilicus towards ASIS]
regional dividing lines
transpyloric
intertubercular/transtubercular
midclavicular(R/L)
intertubercular/transtubercular
midclavicular(R/L)
regions
R/L hypochondriac
R/L lumbar/flank/lateral
R/L inguinal/ilian
epigastric
umbilical
pubic/hypogastric
R/L lumbar/flank/lateral
R/L inguinal/ilian
epigastric
umbilical
pubic/hypogastric
aorta palpation
below umbilicus
also with ab aneurysm
also with ab aneurysm
liver palpation
RUQ
R hypochondriac
epigastric
R hypochondriac
epigastric
gallbladder palpation
if enlarged
R hypochondriac
R lumbar
R hypochondriac
R lumbar
stomach/spleen, urinary bladder, ovaries palpation
only if enlarged/distended
kidneys
lower poles of lateral region
ascending colon palpation
only if distending by gas or chyme
descending/sigmoid colon palpation
only with solid feces
uterus
bimanually
R hypochondriac
Liver
Gall Bladder
Small Intestine
Ascending Colon
Transverse Colon
Right Kidney
Gall Bladder
Small Intestine
Ascending Colon
Transverse Colon
Right Kidney
L hypochondriac
Stomach
Liver (tip)
Small Intestine
Transverse Colon
Descending Colon
Pancreas
Left Kidney
Spleen
Liver (tip)
Small Intestine
Transverse Colon
Descending Colon
Pancreas
Left Kidney
Spleen
R Lumbar
Liver
Gall Bladder
Small Intestine
Ascending Colon
Right Kidney
Gall Bladder
Small Intestine
Ascending Colon
Right Kidney
L lumbar
Small Intestine
Descending Colon
Left Kidney
Descending Colon
Left Kidney
R inguinal
Small Intestine
Appendix
Cecum & Ascending Colon
Female -
Right Ovary
Right Fallopian Tube
Appendix
Cecum & Ascending Colon
Female -
Right Ovary
Right Fallopian Tube
L inguinal
Small Intestine
Descending Colon
Sigmoid Colon
Female -
Left Ovary
Left Fallopian Tube
Descending Colon
Sigmoid Colon
Female -
Left Ovary
Left Fallopian Tube
epigastric
Esophagus
Stomach
Liver
Pancreas
Small Intestine
Transverse Colon
Stomach
Liver
Pancreas
Small Intestine
Transverse Colon
umbilical
Stomach
Pancreas
Small Intestine
Transverse Colon
Cisterna chyli
Pancreas
Small Intestine
Transverse Colon
Cisterna chyli
hypogastric
Small Intestine
Sigmoid Colon
Rectum
Right & Left Ureters
Urinary Bladder
Female -
Uterus
Right & Left Ovaries
Right & Left Fallopian Tubes
Male -
Vas Deferens
Seminal Vessicle
Prostate
Sigmoid Colon
Rectum
Right & Left Ureters
Urinary Bladder
Female -
Uterus
Right & Left Ovaries
Right & Left Fallopian Tubes
Male -
Vas Deferens
Seminal Vessicle
Prostate
Auscultation
empty stomach(sitting ULQ-supine epigastric)-> borborygmi (peristalsis)
bowel-when gassy
ab aorta and IVC-pulse sounds and bruits
bowel-when gassy
ab aorta and IVC-pulse sounds and bruits
bruits
abnormal swishing sounds heard over organs, glands or arteries
cleavage line (Langer's)
direction of fibers
incisions should be made with these lines for best healing
incisions should be made with these lines for best healing
stretch marks
rupture of CT fascicles
-perpendicular to langer's
-perpendicular to langer's
scar formation
striae
superficial fasciae
superficial layer-Camper's-adiposee over ab
deep layer-Scarpa's-cont with fasciae lata
deep layer-Scarpa's-cont with fasciae lata
deep fasciae
over musculature and aponeuroses
cont over spermatic cord, pubis and penis
as spermatic fascia, depp perineal fascia and deep penile fascia
cont over spermatic cord, pubis and penis
as spermatic fascia, depp perineal fascia and deep penile fascia
arcuate line
The inferior border of the rectus sheath posteriorly
instrinsic abs
3 layers
3-ply bias bond
provides max strength
3-ply bias bond
provides max strength
External oblique
O: ribs 5-12
I: iliac crest, aponeurosis, pubic tub and crest
N: intercostal T5-12
I: iliac crest, aponeurosis, pubic tub and crest
N: intercostal T5-12
internal oblique
O: iliac crest, thoracolumbar fascia, TP, inguinal ligament
I: rid 10-12, linea alba, pubic symphysis
N: intercostal T10-L1
I: rid 10-12, linea alba, pubic symphysis
N: intercostal T10-L1
transverse abdominis
O: Inner costal cartilages (5) 7-12, thoracolumbar fascia, iliac crest, lat ing lig
I: linea alba, aponeurosis, pubic crest, ing lig
N: intercostal T7-L1
I: linea alba, aponeurosis, pubic crest, ing lig
N: intercostal T7-L1
rectus abdominis
in rectus sheath
O: costal cartilages 5-7. xiphoid p,
I: pubic crest
N: intercostal T5-12
O: costal cartilages 5-7. xiphoid p,
I: pubic crest
N: intercostal T5-12
pyramidalis
absent in 16-25% of pop
O: pub sym, pubis
I: linea alba
N: subcostal T12
O: pub sym, pubis
I: linea alba
N: subcostal T12
abdominal blood supply
superior epigastric(internal thoracic) anastomoses w inferior epigastric(external iliac)
musculophrenic
intercostal 9-12
superficial epigastric(external iliac)
deep circumflex iliac
musculophrenic
intercostal 9-12
superficial epigastric(external iliac)
deep circumflex iliac
abdominal drainage
superficial: superficial and inferior epigastric
axillar via thoracic and thoracicepigastric
femoral via branches of great saphenous
hepatic portal via paraumbilical
deep: parallel deep arteries
axillar via thoracic and thoracicepigastric
femoral via branches of great saphenous
hepatic portal via paraumbilical
deep: parallel deep arteries
superficial inguinal ring/external
triangular interruption in external oblique
transmits:
males-spermatic cord
females-round ligament
transmits:
males-spermatic cord
females-round ligament
external oblique split into 2 crurs
lateral- into pucic tubercle
medial-into pubic symphysis
intercrural- strengthens apex
medial-into pubic symphysis
intercrural- strengthens apex
hernias
small- will bulge during coughing (valsalva fixation)
large-will be visually apparent
large-will be visually apparent
deep internal ring
interruption though transverse fascia, covered by peritoneum
inguinal canal boundaries
anterior-external oblique aponeurosis
superior-falx inguinalis(conjoined tendon)
inferior-inguinal ligament and lat crus
posterior-transveralis fascia
superior-falx inguinalis(conjoined tendon)
inferior-inguinal ligament and lat crus
posterior-transveralis fascia
inguinal triangle
Hesselbach's
-linea semilunaris
-inguinal ligament
-inferior epigastric artery
-linea semilunaris
-inguinal ligament
-inferior epigastric artery
direct hernia
through wall of inguinal canal
indirect hernia
in canal
anterior ab wall
parietal peritoneum
transversalis fascia
rectus sheath
transversalis fascia
rectus sheath
rectus sheath/arcuate line
above umbilicus
-posterior layer: tranversalis abdominis, internal oblique
below umbilicus: terminal edge of posterior layer
-posterior layer: tranversalis abdominis, internal oblique
below umbilicus: terminal edge of posterior layer
umbilical folds/remnants
median-urachus
medial-umbilical A
lateral-inferior epigastric A/V
medial-umbilical A
lateral-inferior epigastric A/V
transversalis fascia
gives rise to deep inguinal ring
falciform ligament
remnant of ventral mesentery
spermatic cord
vas deferens
testicular artery
pampiniform plexus of veins
tunica vaginalis-peritoneum
cremasteric m-int obl
external spermatic fascia-fasca of ext obl
internal spermatic fascia- trans fasc
testicular artery
pampiniform plexus of veins
tunica vaginalis-peritoneum
cremasteric m-int obl
external spermatic fascia-fasca of ext obl
internal spermatic fascia- trans fasc
ab wall layers
skin
subcutaneous fat
ext obl
int obl
trans ab
trans fascia
extra peritoneal fat
peritoneum
subcutaneous fat
ext obl
int obl
trans ab
trans fascia
extra peritoneal fat
peritoneum
scrotum wall layers
skin
dartos fascia/muscle
external spermatic fascia
cremasteric m
--
internal spermatic fascia
extra peritoneal fat
tunica vaginalis
dartos fascia/muscle
external spermatic fascia
cremasteric m
--
internal spermatic fascia
extra peritoneal fat
tunica vaginalis
peritoneal ligaments
mesogastrium
dorsal mesentery
greater omentum
mesentery
mesocolon
mesoappendix
dorsal mesentery
greater omentum
mesentery
mesocolon
mesoappendix
ventral mesentery
falciform
round (teres hepatica)
round (teres hepatica)
lesser omentum
gastrohepatic
porta
hepatoduodenal
porta
hepatoduodenal
dorsal mesentery
-gastrolienal(splenic): short gasric A/V, gastroepiploic A/V
-lieno(spleno)renal: splenic A/V, tail of pancreas
-lieno(spleno)renal: splenic A/V, tail of pancreas
greater omentum
-from greater curvature of stomach
-connects to transverse colon
-4 layers thick
-inferior recess
-connects to transverse colon
-4 layers thick
-inferior recess
peritoneal sacs
lesser omentum(bursa)
epiploic foramen: anterior, posterior, superior, inferior
epiploic foramen: anterior, posterior, superior, inferior
peritoneal fossa
duodenal, cecal, subphrenic, paracolic gutters
nerve supply
walls-T7-L1
floor-obturator N
visceral-ANS- stretch
floor-obturator N
visceral-ANS- stretch