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Undocumented thoughts about Weeks 7-9 lab objectives (abdomen, pelvis, and perineum)

10/12/99 W. Crone (303 FTZ, 629-7439, cronewil@hvcc.edu, www.hvcc.edu/academ/faculty/crone/index.html)

The thoughts below are not intended to be exhaustive, but to be another source of information about the different structures (i.e., these factoids aren't specifically going to be on lecture/lab tests!). They started off as notes to myself and still retain a sketchy character.

NB: for muscles: O-origin, I-insertion, N-enervation, A-action

Abdomen (Ch. 2)

1. skin (epidermis and dermis): Note that these first ten objectives represent the layers of the abdominal wall, from superficial to deep.
2. superficial fascia: can contain fat (see Camper's layer)
3. fatty layer (of Camper):
4. membranous layer (of Scarpa): the potential space between it and the deep fascia of the abdominal muscles can be filled with urine/blood in urinary extravasation
5. external oblique m.: note inferior, medial slanting of fibers
6. internal oblique m.: note superior-aiming slant of fibers
7. transversus abdominis m.:note internally the arcuate line marking when the rectus sheath does not have the aponeurosis of trans. abd. mm. running deep to it.
8. fascia transversalis: relatively firm and membranous
9. extraperitoneal fatty areolar tissue: another place to pack in fat on the abdominal wall
10. parietal peritoneum:
11. xiphisternal junction: ossification by middle age or so
12. costal margin: costal arch from 7th-10th ribs (calcification later in life)
13. pubic symphysis: cartilaginous joint w/disc
14. pubic crest: above that, starts medially and works up to pubic tubercle
15. pubic tubercle: terminates pubic crest, on pubic body where inguinal ligament attaches
16. inguinal ligament: formed by foldover of ext oblique aponeurosis
17. anterior superior iliac spine: inguinal ligament starts from here, TFL, rect. femoris mm. as well
18. tubercle of iliac crest: most lateral point of iliac crest (as landmarks for regions), 6 cm post. to ant sup iliac spine
19. four quadrants of abdomen: from median/transumbilical planes: LUQ (stomach); RUQ (liver), LLQ (sigmoid colon); RLQ (appendix)
20. nine regions of abdomen: MCL, SCP (subcostal plane), TTP (transtubercular: iliac tubercles on iliac crest, around L5): R, L hypochondriac, epigastric// R, L lateral/lumbar region, umbilical// R, L inguinal region, hypogastric. Major contents include thoughts such as pancreas in umbilical region and spleen in L hypochondriac
21. external oblique m: external, fiber slant
22. linea alba: aponeuroses fusing in midline: midline incision to avoid bv and n
23. inguinal canal: oblique passage, 4 cm long, ant wall ext oblique aponeurosis, post wall transversalis fascia, openings are rings. In here are spermatic cord, round ligament and ilioinguinal n. (see below)
24. superficial inguinal ring: opening in aponeurosis of external oblique. Direct inguinal hernia protrudes abd. wall, covered by peritoneum, medial to inf. epigastric, to superficial ring."Turn head and cough"-superficial/external ring
25. deep inguinal ring: through transversalis fascia (abd. fascia). Indirect inguinal hernia lateral to inf. epigastric and down the deep inguinal ring (majority of inguinal hernias).
26. spermatic cord: begins at deep inguinal ring, ends post border of testis, with ductus (vas) deferens, arteries, veins, nerves (ANS and genitofemoral branch to cremasteric) and lymph vessels and layers of internal spematic fascia (from transversalis fascia), cremasteric fascia and mm from int. oblique, and external spermatic fascia from external oblique aponeurosis
27. round ligament:"gubernaculum" of ovaries, attached to labia majora wall (ligament of ovary and round ligament of uterus)
28. ilioinguinal n:* collateral branch of L1 ventral ramus, sensory to scrotum, labia majora
29. internal oblique m: slant of fibers spraying up from iliac crest, most inferior fibers join with trans. aponeurosis for conjoint tendon used in hernia repair
30. transversus abdominis m: horizontal fibers
31. conjoint tendon: fibers of internal oblique m. joining with those of tranversus abdominis m. to form a structure that attaches to the pubic crest; can be used in hernia repair.
32. fascia transversalis: abdominal fascia deep to body-wall mm, preperitoneal fat layer, eg from obesity (accumulator of infections, etc.)
33. inferior epigastric a: enters rectus sheath from below from external iliac, hernia landmark
34. rectus abdominis m: rectus element of abd. wall, surrounded by aponeurosis into rectus sheath
35. superior epigastric a:* continuation of internal mammaries for rectus sheath and its overlying skin
36. falciform ligament: "sickle-shaped" remnants of ventral mesentery of liver--navel
37. ligamentum teres: obliterated umbilical v in inf. margin of falciform ligament (round lig. of liver another name for lig. teres)--leads to ductus venosus (lig. venosum) in liver
38. median umbilical ligament (1): obliterated urachus (allantois) [fetal bladder component] from bladder to navel
39. medial umbilical ligaments (2):* remnants of umbilical arteries that once fed into int. iliac aa.
40. scrotum: from labioscrotal swellings of anterior abd. wall, raphe midline. Lymphatic drainage superficial
41. dartos m: firmly attached to skin, gives"ridging" (wrinkling), in superficial fascia (membranous layer)
42. scrotal ligament (gubernaculum testis):* band of soft CT to post end of testis, guidance if not necessarily pulling, or keeping open inguinal canal. R testicle descends slower than L. Gubernaculum a name really for the embryonic structure.
43. spermatic cord: begins at deep inguinal ring, ends at post testis, with ductus deferens, VAN, and lymphatics. Varicocoele-varicosities of sperm cord veins
44. cremaster m. cremasteric fascia: from int. oblique fascia. Cremasteric mm (strands) in there. Cremasteric reflex from ilioinguinal n (L1) region (thigh) and motor to cremasters from genital branch of genitofemoral n. (L1-2)
45. ductus (vas) deferens: hard and cord-like in feel, vasectomy, derived from mesonephric (wolffian) duct, carries sperm along from epididymis to the ejaculatory duct
46. testicular a: off of L2 or so from the abd. aorta, so deep lymphatics as metastasis in testicular CA
47. testis: should be descended into the scrotum in adults
48. seminiferous tubule:"ramen noodles appearing," site of sperm production in testis
49. tunica vaginalis testis: potential peritoneal space, distortable by hydrocoele (and where testis ends up post to the tunica vaginalis sac)
50. epididymis: sup/postlat to testis, storage there 18-24 h gives sperm mobility.
51. tunica albuginea: dense, white connective tissue capsule of testis
52. seminiferous tubules: oops, doubled up here
53. peritoneum, visceral vs. parietal: remember, both visceral and parietal. Expanses of peritoneum and how some things become retroperitoneal (kidneys developed from posterior mesoderm, the pancreas, duodenum, ascending and descending colons by fusion of dorsal mesentery to dorsal parietal peritoneum)
54. liver, r. l lobes: as divided by falciform ligament, function separately (own arteries, veins)
55. falciform ligament: see above, remnant of ventral mesentery in which the liver developed
56. gallbladder: inf. to liver, storage for bile (contraction from CCK if fatty meal)
57. stomach (gaster): most dilated portion of alimentary canal, prepares food for small intestine, also useful for vomiting
58. greater omentum: a"double fold" of mesentery hanging down from stomach, secondary fusion with transverse colon (for support) laden with fat. Prevents adhesions between visceral/parietal peritoneum. With mobility, can"wall off" infections.
59. spleen: lymphoid organ, not from gut tube, removes abnormal RBCs, stores Fe from recycled RBCs, and initiates immune responses. Worry about rupture with L thoracoabdominal injuries, esp. if already enlarged, e.g., mononucleosis.
60. small intestine: 6 meters, most of digestion here
61. large intestine: larger lumen, slower passage, more bacteria (e.g., vitamin K), water reuptake
62. cecum, ascending colon: cecum: pouch at beginning of large intestine (fermentation spot in rabbits and horses for cellulose). Ascending colon up R side.
63. transverse, descending colon: transverse is large and mobile, descending down the L side. Descending colon often site of"apple core" CA lesions.
64. sigmoid colon: at distal end of descending colon, at the level of the iliac crest
65. alimentary canal (GI tract). Common adult bowel twist is sigmoid volvulus.
66. pylorus: exit from stomach. Pyloric stenosis in male infants: projectile vomiting.
67. lesser curvature: R concave border.
68. lesser omentum: the"mesentery" between the liver and the stomach, so that the liver's mesenteric connections (VAN, common bile duct) run through this. With rotation of liver to R and stomach to L, end up with omental bursa dorsal to it.
69. hepatogastric ligament: part of lesser omentum, from liver to stomach
70. hepatoduodenal ligament: part of lesser omentum, the R free margin, from liver to duodenum. In here runs hepatic artery, portal vein, bile passages. Dorsal to this ligament is the omental foramen into the omental bursa.
71. greater curvature: L concave border.
72. gastrocolic portion: from stomach to colon portion of greater omentum.
73. duodenum: C-shaped around the pancreas. Buffers chyme, duodenal ulcers here.
74. duodenojejunal junction: when immobile duodenum ends and mobile jejunum begins
75. jejunum: proximal 40%. Thicker, more vascular, redder, often empty. Caliber of lumen larger, plicae circulares palpable here. Most of absorption here.
76. ileum: distal 40%. Peyer's patches more common here, vascular arcades more complicated. Bile acids absorbed here as part of enterohepatic circulation.
77. ileocecal junction: 2.5 cm inferiorly, appendix opens.
78. root of mesentery: between #60 and #63, short tether for small intestine mesentery
79. cecum: a blind intestinal pouch with no mesentery
80. vermiform appendix: variable position, lymphoid organ, small lumen, so often obstructed into appendicitis
81. r colic flexure: up by the R liver lobe, ascending colonà transverse colon
82. l colic flexure: by inferior L kidney, transverse colonà descending colon. Superior and inferior mesenteric arteries anastomose at this point.
83. phrenicocolic ligament:* attaches L colic flexure to diaphragm (fold of peritoneum) (see splenorenal ligament)
84. transverse mesocolon: mesentery of transverse colon, attached near inferior pancreatic border.
85. rectum: fixed terminal part of intestine. Pelvic, begins at S3 level.
86. teniae coli: 3 longitudinal bands begin at appendix (location guide) and run in colon outer surface.
87. haustra: the teniae coli keep colon under tension, forming sacculations of haustra
88. appendices epiploicae: pouches of peritoneum filled with fat along the colon.
89. liver, diaphragmatic surface: extensive, convex, smooth; visceral surface: contact with viscera, inferior
90. porta hepatis: deep transverse fissure inferiorly that contains portal vein, hepatic artery, bile duct."Crossbar of H", with L side for ligamenta venosa and teres, and R side for gall bladder, IVC fossa.
91. hepatic a: off of celiac trunk, arterial supply to liver tissue
92. portal v: venous supply of digestion products from intestine, created by junction of splenic and superior mesenteric veins. Valveless, so when backed up,"exciting" anastomoses, eg hemorrhoids, varices
93. bile passages: e.g., R, L hepatic ducts joining cystic duct to form common bile duct
94. omental foramen: the opening that is posterior to the portal vein, hepatic artery, and bile duct; possible trapping spot for small intestine loop
95. omental bursa: "lesser sac," space behind stomach partially created by lesser omentum (and splenic ligaments), so a concern if a posterior perforation of stomach
96. splenorenal ligament: think of the spleen growing in the dorsal"mesogatrium" and splitting it, hence forming a dorsal portion of phrenicolic ligament and splenorenal ligament, and a ventral portion of...
97. gastrosplenic ligament: the greater omentum, with regional sections of gastrosplenic ligment, gastrophrenic ligament, and the (large) gastrocolic ligament (ie, what we call the greater omentum)
98. peritoneal gutters (name the paracolic ones): thanks to peritoneal attachments, additional passageways for fluids, infections, metastases, etc. Two paracolic gutters, two on either side of small intestine mesentery.

1. bare area: area of liver uncovered by peritoneum near diaphragm
2. coronary ligament: peritoneal reflections around the bare area
3. hepatorenal pouch: potential space inferior to hepatorenal ligament, or the lowest point of the peritoneal cavity (think fluid, cell accumulation)
4. four peritoneal gutters: as above during your in situ exploration
5. common bile duct: fusion of cystic and hepatic ducts in edge of lesser omentum
6. cystic duct: drainage of gall bladder
7. cystic artery:* supply to gall bladder, may be variable in its origin (important for cholecystectomy!)
8. common hepatic duct: fusion of R, L hepatic ducts
9. common hepatic a: from celiac trunk, about 20% of blood flow, drains into sinusoids, along with portal vein blood
10. l., r. hepatic aa.: from common hepatic art. Right hepatic a. supplies right lobe and the left hepatic a. supplies left, caudate, and (most of) quadrate lobes.
11. gastroduodenal a.: off of common hepatic a., supplies stomach, pancreas, first part of duodenum
12. r. gastric a.: off of hepatic art., supplies right portion of stomach's lesser curvature
13. celiac trunk a: supplies stomach, duodenum, and other regional viscera. 3 branches:
14. splenic a: "left squiggly," supplies dorsal mesogastrium organ of spleen
15. l gastric a: aims towards stomach lesser curvature (left portion)
16. l., r. gastroepliploic aa. (gastro-omental aa.): right off of gastroduodenal a., left off of splenic a.; they supply the greater curvature of the stomach.
17. splenic v: inferior to splenic artery--follow it to portal vein
18. portal v: as described above, drainage of gut with absorbed foodstuffs
19. superior mesenteric v: largest portal v. tributary, follows the artery
20. inferior mesenteric v: typically drains into splenic v.
21. superior mesenteric a: blood supply of primary intestinal loop, covers from (partway through) dudodenum to L colic flexure
22. intestinal a a: branches of superior mesenteric artery
23. inferior mesenteric a: from L colic flexure to rectum
24. l colic a: portion of inf. mesenteric that supplies descending colon
25. sigmoid a a: supply the sigmoid colon (4 branches) (inf. mesenteric continues downward as superior rectal artery)
26. suspensory ligament of duodenum (ligament of Treitz):* supports duodenal flexure, widening its angle and keeping intestinal contents going. Muscular portion attached to crura of diaphragm.
27. pancreas: retroperitoneal, head surrounded by duodenum
28. inferior vena cava: drainage of lower part of body except for portal system
29. major duodenal papilla: 8-10 cm distal to pylorus, the opening into the duodenum (papilla of Vater) (ampulla of Vater is also known as the hepatopancreatic ampulla).
30. main pancreatic duct: runs through length of pancreas, for exocrine function
31. sphincter of Oddi: guards opening of ampulla entrance; thickened wall of the common portion of bile, pancreatic ducts
32. quadrate lobe of liver: functionally part of L lobe; by gall bladder
33. caudate lobe: functionally part of L lobe; by IVC
34. ligamentum venosum:* remnants of ductus venosus shunting umbilical blood around liver; along side the caudate lobe.
35. hepatic v v:* several veins draining into IVC, representing coalesced central veins from liver lobules
36. plicae circulares: permanent circular folds of mucous membrane best seen in jejunum
37. ileocecal valve: slight fold that helps to control flow from one to other
38. retroperitoneal space:* i.e.,"below" peritoneum, but"before" the body wall muscles: kidneys, etc.
39. r, l kidneys
40. r., l testicular v v:* note difference, R vein into IVC, L vein into L renal vein
41. r, l renal a a: short, at right angles off of abdominal aorta
42. ovarian a, v:* off of abdominal aorta inferior to renal arteries
43. perirenal fat (adipose capsule): lots of packing!
44. renal pelvis: enlargement leading to ureters (L.-basin)
45. ureter: thick-walled, muscular ducts; renal colic from kidney stones
46. fibrous capsule: gives kidney a glistening appearance; should be able to peel off
47. renal cortex: outer functional layer of kidney: Bowman's capsule, convoluted tubules (renal columns are reachdown of cortex between medullary pyramids, consisting mostly of interlobar arteries)
48. renal medulla (pyramids): 8-18, represent loops of Henle, vasa recta, and collecting ducts
49. renal papilla(-ae): apex of each renal pyramid, opens into a (minor) calyx
50. calyces: branches of pelvis
51. suprarenal (adrenal) glands: cortical hormones (aldosterone, cortisol), medullary hormones of epinephrine and norepinephrine
52. common iliac a: stem from bifurcation of abdominal aorta
53. psoas major m: flexes thigh at hip joint
54. iliacus, iliopsoas mm.: from iliac crest to blend in with psoas major (femoral n)
55. quadratus lumborum m: affect on vertebral column, extend, laterally flex (still a hypaxial mm, innervated by ventral rami of T12-L4).
56. genitofemoral n: from L1/L2, on anterior surface of psoas major. Cremaster muscle.
57. lateral femoral cutaneous n: from L2/L3. Deep to inguinal ligament near ASIS. Meralgia paresthetica or burning sensation on lateral femoral region if the patient is fat and there is impingement of this nerve.
58. femoral n: (lumbrosacral plexus, L2-4) exits under inguinal ligament, major supply to anterior thigh mm. Large n. between psoas major and iliacus mm.
59. obturator n: (lumbrosacral plexus, L2-4), leaves through obturator foramen, adductor muscles of thigh; find at medial border of psoas major m.
60. r, l crus (L. leg) of diaphragm: arise from lumbar vertebrae, blend in with anterior longitudinal ligament along the vertebral bodies. Right crus > left
61. medial arcuate ligament:* thickenings of thoracolumbar fascia (posterior aponeurotic sheets from internal oblique and transversus abdominis). Medial arcuate ligament has a gap for psoas major mm..
62. lateral arcuate ligament:* covers superior aspect of quadratus lumborum mm.
63. central tendon: aponeurosis of diaphragm
64. vena caval foramen: see in central tendon
65. esophageal hiatus: to its left
66. aortic hiatus: most inferior opening, surrounded by crura

1. pelvic brim: formed by pubic crest--iliac arcuate lines--sacral promontory
2. greater pelvis (false): part of abdominal cavity, between iliac fossae
3. lesser pelvis (true): pelvic cavity, integral part of birth canal
4. pelvic diaphragm: formed by levator ani and coccygeus mm., closes the pelvic outlet
5. anal region: posterior triangle of perineum
6. urogenital region: anterior triangle of perineum
7. perineum: that part of the trunk inferior to the pelvic diaphragm, with a diamond shape created by pubic symphysis, ischial tuberosities, and coccyx
8. r, l os coxae (hip bones): made of ilium, ischium, and pubis that meet at acetabulum
9. sacrum: fused vertebrae S1-S5, 4 pairs of foramina for sacral nerves
10. coccyx: tail remnant, usually 4 rudimentary vertebrae; coccydynia or pain in coccygeal region from falling
11. pelvic inlet (superior aperture): larger, rounder in female than male
12. sacral promontory: encroaches upon pelvic inlet, created by anterior projection of S1 body
13. symphysis pubis: with a thick fibrocartilage disc
14. obturator foramen: covered by obturator fascia, obturator nerve enters thigh via it.
15. ischial tuberosity: weight-bearing when sitting
16. ischial spine: separates greater from lesser sciatic notch, may project into the fetal passageway
17. sacrospinous ligament: from sacrum (and coccyx) to ischial spine
18. sacrotuberous ligament: from sacrum to ischial tuberosity
19. lesser sciatic foramen: defined by ischial spine, the sciatic notches and associated ligaments above. Items to the perineum leave pelvis here.
20. greater sciatic foramen: defined as above. Items to the lower extremity leave pelvis here.
21. pubic arch: inferior to symp. pubis, wider in females than in males
22. anterior sacral foramina: four, for sacral nerves
23. sacral canal: sacral hiatus leads into this, the end of the vertebral canal. Site for epidural (or caudal) anesthesia, with extradural spread of anesthesia.
24. sacroiliac articulation: strong synovial joints held into place by sacroiliac ligaments
25. transverse diameter: the greatest width of the pelvic inlet
26. pelvic outlet (inferior aperture): bounded by sacrum (+ coccyx), ischial spines, and pubic symphysis.
27. anteroposterior (conjugate) diameter: pelvic inlet measurement of pubic symphysis to sacral promontory
28. gluteus maximus m: large heavy m. over ischial tuberosity, powerful extensor, lateral rotator
29. ischioanal (ischiorectal) fossa: on either side of anal canal, expansion space for feces (can get ischioanal abcesses in there)
30. sphincter ani externus: voluntary sphincter, blends with puborectalis part of levator ani
31. obturator internus m: covers much of the internal wall of the true pelvis, leaves via lesser sciatic foramen to reach greater trochanter (so a lateral rotator)
32. pudendal canal + n:*made from obturator fascia, on lateral walls of the ischioanal fossa, carries from ischial spine (lesser sciatic foramen) to posterior edge of urogenital diaphragm. Pudendal nerve (ventral rami of S2-4) suppplies most of innervation to perineum.

1. superficial fascia with fatty and membranous layers: this distinction made because of the phenomenon of extravasation (e.g, secondary to straddle injury).
2. superficial perineal space: Should really be a space, not a pouch. The space between the inferior fascia of the urogenital diaphragm (perineal membrane) and the membranous layer of subcutaneous tissue (superficial fascia) of the perineum (Colles' fascia; remember that discussion with the abdominal wall?) Dramatic urinary extravasation can occur here.
3. perineal body:* located at center of perineum, where a number of muscles and CT converge. External anal sphincter, urogenital diaphragm, some of levator ani's preanal thickening, etc. Particularly important in women as a site of perineal support.
4. urogenital diaphragm: a sheet of hypaxial muscle, part of which becomes the urethral sphincter muscle, sandwiched by fascia (the perineal membranes) on either side. Can find bulbourethral (Cowper's) glands in here (the deep perineal space).
5. bulbourethral (Cowper's) gland in deep perineal space.* These form a lubricating secretion into the membranous urethra.
6. external urethral sphincter m.: the voluntary sphincter muscle, in the deep perineal space.
7. ischiocavernosus m:* surround the crura of the penis (beginnings of the corpora cavernosa); help to maintain erection
8. bulbospongiosus m:* surround the bulb of the penis (beginning of corpus spongiosum in between the crura)
9. glans penis: head of penis
10. spongy urethra: the part of the urethra going through the penis
11. external urethral orifice: meatus of penis
12. corpus cavernosum: one of paired bodies of spongy, erectile tissue
13. corpus spongiosum: the midline, unpaired body that has the spongy urethra running through it
14. rectovesical pouch (fossa): a peritoneal-lined pouch between anterior rectum and posterior bladder
15. retropubic space (prevesical): fat-filled space anterior to bladder to accomodate long highway trips with lots of coffee
16. retrorectal space (presacral): location as implied
17. internal iliac a: supplies most of blood to pelvic viscera and gluteal region
18. obturator canal: crosses the superior part of the obturator membrane
19. obturator a: variable origin; supplies thigh mm.
20. internal iliac v: main drainage of pelvis
21. external iliac v: extension of femoral vein, starts at inguinal ligament
22. common iliac v: union of L & R forms the IVC
23. ureter: anterior to internal iliac arteries
24. ductus deferens: from tail of epididymis to seminal vesicle; lies external but adherent to pariet. peritoneum; carry sperm
25. levator ani m (puborectal sling): the main muscle of the pelvic diaphram, funnel-shaped; puborectalis part forms a sling around rectum that relaxes during defecation
26. coccygeus m: the other muscle of pelvic diaphragm, posterior (in dogs, the m. responsible for"tail between the legs") (Remove bladder, prostate gland, and seminal vesicles in one piece)
27. membranous urethra: that part of the urethra that goes across the urogential diaphragm and therefore surrounded by the sphincter urethrae; hence, in the deep perineal space
28. prostatic urethra: that part that goes through the prostate, widest and most dilatable spot of the urethra
29. prostate gland: largest accessory gland of male reproduction, BPH and prostate CA; watery, acid phosphatase secretions. Superior to urogenital diaphragm
30. ampulla: of ductus deferens. Sperm stored here prior to ejaculation.
31. seminal vesicles: next to ampullae on posterior bladder, create most of secretions, with sucrose
32. ejaculatory duct: leading from these to run through prostae to reach urethra
33. urinary bladder
34. trigone: triangle on post. wall of bladder formed by uretal and urethral orifices
35. anal canal: 4 cm long, from puborectalis sling on down
36. anal columns: (rectal columns), folds of mucuous membranes. Anal valves connect them distally. The level of anal valves is the pectinate line, above which internal hemorrhoids (which don't hurt), and below which, external hemorrhoids, which do hurt.
37. piriformis m: travels through greater sciatic foramen, landmark of gluteal region; lateral rotator of thigh.
38. sacral plexus:* from S1-S4 ventral rami, main nerves of sciatic and pudendal.

1. urethra: short, about 4 cm long, so higher UTI rate than in males
2. vagina: muscular sheath, copulatory organ
3. uterus: with body and cervix
4. fornix: vaginal recess around cervix
5. mons pubis: fatty pad anterior to symphysis pubis, covered with pubic hairs
6. labia majora: homologous to male scrotum, filled with subcutaneous fat
7. labia minora: hairless skin folds in between the labia majora
8. vestibule of vagina: space between labia minora, containing vagina, urethra, and greater vestibular (Bartholin's) glands
9. clitoris: homologous to penis, with erectile tissue (no urethra running through it, so no corpus spongiosum)
10. vaginal orifice: opening to vagina
11. urethral orifice: anterior to vaginal orifice
12. perineal body: as described above, try to avoid damaging during childbirth (e.g., by performing episiotomy)
13. urogenital diaphragm: see above: sheet of hypaxial muscle with urethral sphincter surrounded by perineal membranes; offers anterior support to pelvic structures
14. round ligament (uterus): that giant gubernaculum that ends in the labia majora
15. superficial, deep perineal spaces
16. ischiocavernosus m:* this and the next muscle are harder to find in women than in men, but in homologous locations
17. bulbospongiosus m:* note that it's divided by the vaginal orifice
18. bulbs of vestibule:* separated from the clitoris and spaced apart by the vagina
19. greater vestibular gland (Bartholin's):* open on either side of vagina, lubricating, often infected; below bulb of vestibule; in superficial perineal space
20. vesicouterine pouch: lined by peritoneum between bladder and uterus
21. rectouterine pouch: (of Douglas), lined by peritoneum between uterus and rectum, reachable by culdoscopy through fornix
22. broad ligament (uterus): draping of peritoneum over uterus and fallopian tubes
23. uterine tube: fallopian tubes
24. mesosalpinx: that part of the broad ligament between the ligament of the ovary (gubernaculum remnant), ovary, and fallopian tube
25. ovary: female gonad, see on posterior side of uterus
26. mesovarium: a fold of peritoneum that connects ovary to broad ligament
27. ovarian ligament: gubernaculum remnant, does"berm shot" off of uterus, continues as round ligament of uterus (heading off to inguinal canal, right?)
28. suspensory ligament: connects ovary to lateral wall, contains ovarian vessels and nerves
29. sacrouterine ligaments:* (uterosacral lig.) condensation of pelvic (extraperitoneal) fascia containing smooth mm.; from sides of cervix to middle of sacrum, deep to peritoneum and superior to levator ani
30. transverse cervical ligaments:* same construction as above; extend to lateral pelvic walls
31. retropubic space: for bladder expansion
32. retrorectal space: parallel discussion for these structure as with male cadavers
33. internal iliac a
34. obturator canal
35. obturator a
36. internal iliac v
37. external iliac v
38. common iliac v
39. levator ani m: important for support of pelvic organs; weakening from repeated childbirth leads to risk of prolapse
40. coccygeus m (Remove bladder, proximal urethra, uterus, tubes, and ovaries)
41. ureter: crosses underneath uterine artery (important for hysterectomy-don't tie off the ureters!)
42. uterine artery:* runs along side of the ureter as the ureter runs to the bladder, and then along side of uterine body and supplies superior vagina as well.
43. urinary bladder
44. trigone
45. cervix: protrudes into vaginal canal. Opening may appear lacerated after childbirth
46. cervical canal: opens through cervix, be sure to"swab" for pap smears, in addition to outer surface scrape
47. body (uterus): palpable on bimanual exam
48. uterine cavity: space inside body of uterus
49. endometrium: mucosal lining of uterus in uterine cavity
50. myometrium: thick smooth muscle wall of uterus
51. fundus: the rounded part of the uterine body above where the uterine tubes enter
52. infundibulum (fimbriae): infundibulum is the funnel-shaped distal end of the fallopian tubes, while the finger -like fimbriae help to"sweep" the egg up during ovulation
53. isthmus: narrow middle of fallopian tube, or depending on context, the narrowing between the uterine body and cervix
54. anal canal
55. anal columns
56. piriformis m
57. sacral plexus:*

|main page| |background| |03028: Physiology| |03048: Anatomy|

|03050: Invertebrate Zoology| |03051: Vertebrate Zoology| |03074: Economic Botany|

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Copyright 1999 by Wilson Crone

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This page updated on October 25, 1999