Term
| branch out the common and external iliac |
|
Definition
common > external > femoral
branches of external: first deep circumflex iliac, 2nd inferior epigastric |
|
|
Term
| where does the internal iliac split |
|
Definition
|
|
Term
| where does the uterine artery split |
|
Definition
|
|
Term
| the hypogastric artery is aka |
|
Definition
|
|
Term
| divisions of the internal iliac artery |
|
Definition
|
|
Term
| branches of the posterior iliac artery in order |
|
Definition
| 1 ileolymbar, 2 internal sacral, 3 superior gluteal |
|
|
Term
| branches of the anterior iliac artery in order |
|
Definition
| 1 umbilical, 2 obturator, 3 inferior vesicle, 4 uterine, 5 middle rectal, 6 internal pudendal, 7 inferior gluteal |
|
|
Term
| which anterior division of the iliac branches have their own grabches |
|
Definition
|
|
Term
| branches of the umbilical branch of the hypogastric artery |
|
Definition
|
|
Term
| branches of the uterine artery and what they supply |
|
Definition
| superior which anastomosis with the ovarian and inferior/vaginal which supplies vagina and cervix |
|
|
Term
|
Definition
| median umbilical ligament |
|
|
Term
| blood supply to the vagina |
|
Definition
| upper vagina: vaginal branch of the uterine artery. lower vagina: initernal pudendal artery below the levator ani |
|
|
Term
| venous drainage of the vagina |
|
Definition
|
|
Term
| course of the uteter - 6 steps |
|
Definition
| along anterior psoas until pelvic inlet, over iliac vessels at bifurcation at greater sciatic foramen, anterior to iliacs and lateral to uterosacral ligaments, medial leaflet of the base of the broad ligament, under uterine artery 1.5cm lateral to internal os, over anterior vagina to trigone |
|
|
Term
|
Definition
| adventitial sheath, inner smooth muscle, transitional mucosal epithelium |
|
|
Term
| length of the ureter - total, abdominal, pelvic |
|
Definition
| 30cm (15cm abdominal, 15cm pelvic) |
|
|
Term
| most common location of injury on the length of the ureter |
|
Definition
|
|
Term
| blood supply to the lower segment of the ureter - 4 |
|
Definition
| uterine, vaginal, middle hemorrhoidal, vesical arteries |
|
|
Term
| blood supply to upper and middle segment of the ureter - 4 |
|
Definition
| renal, ovarian, aortic, common iliac arteries |
|
|
Term
| muscles and ligaments of the pelvic diaphragm - 6 |
|
Definition
| perirectal fibers, obturator internus, levator ani, coccygeus, piriformis, anococcygeal ligament |
|
|
Term
| parts of the levator ani and where they are located - 3 |
|
Definition
| puborectalis (inner next to vagina.rectum, pubococcygeus (Y connecting tentinous arch of levator ani to sacrum), iliococcygeus (inner most layer filling space between pubococcygeus and coccygrus, connects to ischial spines and tendinous arch of levators) |
|
|
Term
| location of piriformis and coccygeus in pelvic diaphragm |
|
Definition
| piriformis - most posterior connecting pelvic brim to sacrum, coccygeus - second to back connecting sacrum to ischial spines |
|
|
Term
| relation of the ureter under the ovarian artery from 2 landmarks |
|
Definition
| 2cm from the ischial spines, 1.5cm from the internal os |
|
|
Term
| obturator canal anatomy of arteries and nerves |
|
Definition
| enter in a hole in the outer right quadrant of the membrane, the arteries then go along the top and lateral edges, pudendal nerve does not enter it scoops around the lateral most and posterior edge internally of the canal |
|
|
Term
| origin of the pudendal nerve |
|
Definition
|
|
Term
| muscles affected by the obturator nerves |
|
Definition
| adductor LONGUS, adductor BREVIS, adductor MAGNUS, pectinus, obturator EXTERNUS |
|
|
Term
|
Definition
|
|
Term
| muscles affected by pudendal nerve |
|
Definition
|
|
Term
| motor function obturator nerve |
|
Definition
| aDDuction of the upper leg |
|
|
Term
| motor function pudendal nerve |
|
Definition
| rotation of thigh away from the body |
|
|
Term
| pathway of anatomy for a TOT |
|
Definition
| periurethral endopelvic fascia > obturator internus > obturator membrane > obturator externus > adductor muscles > gracilis > SQ fat, skin |
|
|
Term
| internal anal sphincter - muscle, function |
|
Definition
| circular smooth muscle, 75% of resting tone, autonomic function |
|
|
Term
| external anal sphincter - muscle, function |
|
Definition
| striated muscle, voluntary control |
|
|
Term
| support of the uterus - 2 |
|
Definition
| cardinal and uterosacral ligaments |
|
|
Term
| level 1 pelvic support - 6 |
|
Definition
| apical - cardinal ligaments, uterosacral ligaments, puboRECTAL/rectoVAGINAL fascia, parantherium, pericovpium |
|
|
Term
| level 2 pelvic support - 4 |
|
Definition
| lateral - puboCERVICAL/rectoVAGINAL fascia, arcus tentinous fasciae pelvis, levator ani |
|
|
Term
| level 4 pelvic support - 1 |
|
Definition
| distal fusion - perineal body |
|
|
Term
| location of the obturator nerve in lymph node dissection |
|
Definition
| initially lateral to the common iliac, then is medial divider between the external and internal iliac branches |
|
|
Term
| location of the genitofemoral nerve in lymph node dissection |
|
Definition
| more lateral and superior to the external iliac |
|
|
Term
| pneumonic for branches of posterior division of the hypogastric artery in order |
|
Definition
| I Love Lemons So So Good - iliolumbar, Lateral Sacral, Superior Gluteal |
|
|
Term
| pneumonic for the branches of the anterior division of the internal iliac |
|
Definition
| U ordered IV unicorns, MR. I'm Glad I'm Pleased - umbilical, obturator, Inferior Vesicle, Uterine, Middle Rectal, Internal Pudendal, Inferior Gluteal |
|
|
Term
| explain the rectus muscle above the arcuate line |
|
Definition
| the internal oblique, external obligue, and transversus combine into one tendon that splits and encases the rectus muscles making an anterior and posterior rectus sheath |
|
|
Term
| explain the rectus muscle below the arcuate line |
|
Definition
| the internal oblique, external oblique, and transversus muscles make a common tendon that go in front of the rectus muscles |
|
|
Term
| blood supply to the abdominal wall lower |
|
Definition
internal - external iliac gives off the deep circumflex iliac which goes lateral and the inferior epigastric which goes superior.
external - the femoral artery gives off the superficial epigastric that goes superior and the superficial circumflex iliac that goes lateral. It also gives off the external pudendal that goes towards the mons |
|
|
Term
| blood supply to the upper abdominal wall |
|
Definition
| the subclavian gives off the internal thoracic which splits into the superior epigastric |
|
|
Term
| incidence of nerve injuries |
|
Definition
|
|
Term
| most common type of nerve injury |
|
Definition
|
|
Term
| most common surgeries for nerve injuries |
|
Definition
|
|
Term
| risk factors for nerve injury - 7 |
|
Definition
| skinny, retractors, stirrups, frog leg, transverse incisions, long procedure, leaning on patient |
|
|
Term
| first degree nerve injury - physiology, outcome/management |
|
Definition
| transient ischemia, expectant management, no clinical effect |
|
|
Term
| second degree nerve injury - name, physiology, management, outcome |
|
Definition
| neuropraxia, ischemia and reversible myelin injury, transient paresis, expectant management, regenerates within 6wk |
|
|
Term
| third degree nerve injury - name, physiology, cause, management, outcome |
|
Definition
| axonotmesis, axon injury but CT in tact, usually due to stretch, expectant management, regenerates in months to years |
|
|
Term
| fourth degree nerve injury - name, physiology, outcome |
|
Definition
| neurotemesis, axon destruction, will have residual neurological effects |
|
|
Term
| origin ilioinguinal/iliohypogastric nerves |
|
Definition
|
|
Term
| ilioinguinal/iliohypogastric nerves - incidence of injury |
|
Definition
|
|
Term
| ilioinguinal/iliohypogastric nerves - course |
|
Definition
| lateral to psoas, under surface of abdominal wall, inguinal canal |
|
|
Term
| ilioinguinal/iliohypogastric nerves - motor function |
|
Definition
|
|
Term
| ilioinguinal/iliohypogastric nerves - sensory function |
|
Definition
| groin, mons, labia majora, upper medial thigh |
|
|
Term
| ilioinguinal/iliohypogastric nerves - risks for injury - 4 |
|
Definition
| pfannestiel, inguinal LND, LSC trocar >10mm in lower quadrant, TVT |
|
|
Term
| ilioinguinal/iliohypogastric nerves - prevention of injury - 3 |
|
Definition
| avoid incisions below the ASIS, stay within the lateral edges of the rectus muscles, stay 2cm above the pubic symphysis |
|
|
Term
| genitofemoral nerve - origin |
|
Definition
|
|
Term
| genitofemoral nerve - course |
|
Definition
| through psoas and bifurcates into genital which goes through the inguinal ligament, and femoral which goes to the femoral sheath |
|
|
Term
| genitofemoral nerve - motor function |
|
Definition
|
|
Term
| genitofemoral nerve - sensory function |
|
Definition
| genital: sensation to labia, femoral: sensation to anterior upper thigh |
|
|
Term
| genitofemoral nerve - risk of injury |
|
Definition
|
|
Term
| which 3 nerves are impossible to distinguish which was injured |
|
Definition
| genitofemoral nerve, ilioinguinal nerve, iliohypogastric nerve |
|
|
Term
|
Definition
|
|
Term
|
Definition
| lateral to psoas, exits under inguinal ligament |
|
|
Term
| femoral nerve - motor - 4 |
|
Definition
| iliopsoas hip flexion, pectineus hip adduction, quadriceps leg extension, patellar reflex |
|
|
Term
| femoral nerve - sensory - 4 |
|
Definition
| anterior medial thigh, knee, medial leg, dorsum of foot |
|
|
Term
| femoral nerve - risk for injury - 3 |
|
Definition
| frog leg, self-retaining retractors, severe hip flexion |
|
|
Term
| femoral nerve - clinical signs of injury - 3 |
|
Definition
| cannot stand from seated, fall during ambulation, decreased patellar DTR |
|
|
Term
| femoral nerve - prevention of injury |
|
Definition
| use shortest retractor blades needed, done compress the psoas muscle |
|
|
Term
| three nerves that cause paresthesia of the thigh |
|
Definition
| anterior - femoral, lateral - lateral femoral cutaneous, medial - genitofemoral |
|
|
Term
| lateral femoral cutaneous - motor function |
|
Definition
|
|
Term
| lateral femoral cutaneous - sensory function |
|
Definition
|
|
Term
| lateral femoral cutaneous - mode of injury |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| along psoas, pelvic side wall, obturator foramen, obturator canal |
|
|
Term
| obturator nerve - motor function - 4 |
|
Definition
| adductor magnus, brevis, longus, obturator EXTERNUS |
|
|
Term
| obturator nerve - sensory function - 3 |
|
Definition
|
|
Term
| obturator nerve - mechanisms of injury - 7 |
|
Definition
| extreme lithotomy, frog leg, osteitis pubis edema, burch, paravaginal repair, TOT |
|
|
Term
| obturator nerve - clinical signs of injury - 3 |
|
Definition
| waddling gait, adduction weakness, DTR preserved |
|
|
Term
|
Definition
|
|
Term
|
Definition
| common sheath has medial/tibial nerve and lateral/peroneal nerve inside it, passes below piriformis, exits greater sciatic notch into gluteal muscles, divides into peroneal and tibial nerves in posterior leg |
|
|
Term
| sciatic nerve - motor function |
|
Definition
| leg flexion/hamstring, ankle reflex |
|
|
Term
| sciatic nerve - sensory function |
|
Definition
| back of leg and butt down to little toe |
|
|
Term
| sciatic nerve - risk of injury - 2 |
|
Definition
| high lithotomy, sacrospinous ligament fixation |
|
|
Term
| sciatic nerve - clinical signs of injury - 3 |
|
Definition
| weakness of most of the lower leg, mostly sensory deficits and pain |
|
|
Term
|
Definition
| lateral trunk of the sciatic nerve |
|
|
Term
|
Definition
| behind fibular head to peroneas longus muscle and foot |
|
|
Term
| sciatic nerve - motor function |
|
Definition
| abduction, dorsiflexion, eversion |
|
|
Term
| sciatic nerve - sensory function |
|
Definition
| anterior lateral leg, foot dorsum |
|
|
Term
| sciatic nerve - mechanisms of injury 4 |
|
Definition
| yellow fins, knee hitting candy canes, frog leg, leaning assistant |
|
|
Term
| sciatic nerve - clinical signs of injury - 3 |
|
Definition
| slapping gait, foot drop, sensory deficit to anterior lower leg/foot dorsum |
|
|
Term
| tibial nerve - motor function |
|
Definition
|
|
Term
| tibial nerve - sensory function |
|
Definition
| back of lower leg, sole of foot |
|
|
Term
| tibial nerve - signs of injury |
|
Definition
| weak plantar flexion, decreased sensation to back of leg |
|
|
Term
|
Definition
| the origin of the pudendal nerve S2-4 |
|
|
Term
| what is the origin of the pudendal nerve |
|
Definition
|
|
Term
|
Definition
| proximal to the sacrospinous ligament, through the sciatic notch, back through the sciatic notch, along ALOCK'S CANAL, divides into three branches |
|
|
Term
| pudendal nerve - 3 branches |
|
Definition
| hemorrhoidal/inferior rectal, perineal, dorsal nerve of the clitoris |
|
|
Term
|
Definition
| fascia tunnel of the obturator interus that the pudendal nerve goes through |
|
|
Term
| pudendal nerve - hemorrhoidal branch - motor and sensory |
|
Definition
| motor - external anal sphincter, sensory - perianal skin |
|
|
Term
| pudendal nerve - perineal branch - motor and sensory |
|
Definition
| motor - perineal muscles, external urethral sphincter. sensory - perineal skin. |
|
|
Term
| pudendal nerve - dorsal nerve of the clitoris - motor, sensory |
|
Definition
| motor none, sensory: clitoris things |
|
|
Term
| pudendal nerve - mechanisms of injury - 4 |
|
Definition
| chemo, rads, herpes, straddle injury |
|
|
Term
| pudendal nerve - clinical signs of injury - 3 |
|
Definition
| fecal incontinence, urinary incontinence, prolapse |
|
|
Term
| clinical signs of pudendal neuralgia |
|
Definition
| relieved when laying down, painful bladder, burning, urgency, frequency, dysparunea, usually UNILATERAL, parasthesia |
|
|
Term
| diagnosis of pudendal neuralgia |
|
Definition
| relieved by pudendal block |
|
|
Term
| management of pudendal neuralgia - 8 |
|
Definition
| pelvic PT, pudendal block, gabapentin, TCAs, flexeril, vaginal valium, TENs, surgical decompression |
|
|
Term
| meds that can be used in pudendal block - 3 |
|
Definition
| lidocaine, bupivacaine, steroid (Kenalog) |
|
|
Term
| proper angles for hip and knee flexion in high lithotomy |
|
Definition
| hip flexion >60 deg, knee flexion 90-120 deg |
|
|
Term
| proper placement in allen stirrups for avoidance of injury |
|
Definition
| ankle and knee in line with contralateral shoulder, neutral hips, no excessive abduction or external rotation, no hip/knee over flexion |
|
|
Term
| expectant management of nerve injuries - 4 |
|
Definition
| analgesic, heat, massage, electrical stimulation - NOT PT |
|
|
Term
| medical management of nerve injuries - 5 |
|
Definition
| gabapentin, antidepressants, local anesthetics, pain management, nerve blocks |
|
|
Term
| pathway of glandular unit of the breast |
|
Definition
| alveoli > lobule > duct > excretory sinus > ductal oriface > nipple |
|
|
Term
| what holds the glandular units together in the breast |
|
Definition
|
|
Term
| how many glandular units does a breast have |
|
Definition
|
|
Term
| what are the 3 main places the breast lymph drains |
|
Definition
| 75% axillary/pectoral, 20% internal thoracic, 5% posterior intercostal, others: opposite breast, anterior abdominal wall |
|
|
Term
| what are the 3 areas of the axillary/pectoral drainage of the breast |
|
Definition
| 1 - below the pectoralis minor, 2 - under the pectoralis minor, 3 - superior to pectoralis minor |
|
|
Term
| blood supply to the vagina and perineum |
|
Definition
upper vagina - vaginal branch of the uterine artery
middle vaginal - middle rectal artery
lower vaginal - internal pudendal artery
all branches of the anterior division of the internal iliac |
|
|
Term
| barriers of the urogenital triangle, like if there was a hematoma |
|
Definition
ischiopubic ramis - lateral
anal fascia - medial
urogenital diaphragm - posterior
colles fascia/pubic fascia of thigh - anterior
inferior - superficial transverse perineal muscle |
|
|
