10_Pelvis and Perineum Flashcards Preview

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Flashcards in 10_Pelvis and Perineum Deck (56):
1

What is the greater pelvis?

  1. surrounded by the bony pelvis superior to the pelvic inlet. 
  2. Contains the inferior abdominal viscera

2

What is the lesser pelvis?

  1. Region inferior to the pelvic inlet; superior to pelvic outlet. 
  2. Surrounded by the bone or perineum.

3

Describe the perineum.

  1. Consist of surface form the thighs to the butt, from the coccyx to the pubis, the region inferior to the pelvic diaphragm. Also from the anus to the external genitalia. 

4

What are the functions of the pelvic girdle?

  • Consists of bones connecting the vertebra to the femur. The function is weight bearing, transferring weight from the axial skeleton to the lower limbs, and allows locomotion via muscular attachment. 
  • The pelvic girdle consists of the os coxae, sacrum, and pelvic inlet.

5

What is the pelvic girdle?

  • Consists of bones connecting the vertebra to the femur. The function is weight bearing, transferring weight from the axial skeleton to the lower limbs, and allows locomotion via muscular attachment. 
  • The pelvic girdle consists of the os coxae, sacrum, and pelvic inlet.

6

What are the bony structures that form the pelvic girdle?

  • Consists of bones connecting the vertebra to the femur. The function is weight bearing, transferring weight from the axial skeleton to the lower limbs, and allows locomotion via muscular attachment. 
  • The pelvic girdle consists of the os coxae (ishium ,ilium, pubis) , sacrum, and pelvic inlet.

7

What are the boundaries of the pelvic outlet?

  • Anterior: pubic arch
  • Lateral: ischial tuberosity
  • Posterior: coccyx
  • Posterolateral: Inferior margin of the sacrotuberous ligament.

8

Describe the boundaries of the greater pelvis.

  • Superior: pelvic inlet
  • Posterior: SV1
  • Postero-lateral: Iliac ala
  • Antero-superior: Iliac ala
  • Contains the abdominal viscera.

9

Describe the boundaries of the lesser pelvis.

  • Superior: pelvic inlet
  • Inferior: pelvic outlet 
    • visceral ilium, sacrum, and coccyx

10

At what point is the pelvis sitting in the anatomical plane?

Sitting rotated anteriorly about 55 degrees. The pubic tubercle will be withing the same plane as the ASIS

11

The pelvic brim is used to form the pelvic inlet, which separates the lesser and greater pelvis. What forms the pelvic brim?

  • Promontory and the ala of the sacrum
  • The right and left linea terminalis.
    • linea terminalis: arcuate line, pecten pubis, pubic crest

12

What structures combine to form the Right and Left linea terminalis?

  • Arcuate line
  • Pecten Pubis
  • Pubic Crest

13

What articulations are commonly seen in the pelvic girdle?

  • sacroiliac joint
  • lumbosacral joint
  • sacro-coccygeal joint
  • pubic symphysis

14

What are the structures that assist the SIJ with maintaining the axial weight load?

  • Posterior sacro-iliac ligaments:
    • oriented oblique and upward to pull the ilia medially with increase of weight or stress.
  • These support the synovial joint that has limited motion

15

Increased axial load will cause the pelvis to rock anteriorly and rise. What is used to prevent this from happening?

  • The sacrotuberous and sacrospinous ligaments help prevent the anterior/superior motion of the pelvis when axial skeleton load is dramatically increased. 

16

What is commonly broken during a MVA, in the pelvis if you contact the steering wheel? 

  • Pubic symphysis. 
  • Fibrocartilaginous joint bound superiorly and inferiorly by ligaments. that prevent movement. 

17

Where is the lumbosacral joint located?

  • Anterior joint: LV5/SV1
  • Posterior joint: zygopophyseal joint. 
  • Iliolumbar ligaments: consist of a fan-like pattern from TP of LV5 to the ilia. These strengthen the joint. 

18

Describe what measurements are used for determining the size of the birth canal.

  1. True conjugate:  Runs from the middle sacral promontory to the posterior superior margin of the pubic symphysis.  (this is the narrowest point. Also fixed and will not change diameter)
  2. Diagonal Conjugate: the measurement that is able to be obtained clinically. Therefore, contacting sacral promontory with finger, and marking location of inferior margin of pubic symphysis, then subtract 1.5cm will roughly estimate the True conjugate diameter. 

19

Will the true of diagonal conjugate measurement be the "restricting" factor for allowing a vaginal birth? 

  1. True conjugate:  Runs from the middle sacral promontory to the posterior superior margin of the pubic symphysis.  (this is the narrowest point. Also fixed and will not change diameter)
  2. Diagonal Conjugate: the measurement that is able to be obtained clinically. Therefore, contacting sacral promontory with finger, and marking location of inferior margin of pubic symphysis, then subtract 1.5cm will roughly estimate the True conjugate diameter. 

20

What are the walls of the pelvic cavity?

  1. Antero-Inferior Wall
    1. pubic rami and the pubic symphysis
    2. holds the weight of the bladder
  2. Lateral Pelvic Wall
    1. R/L hip bones with the overlaying obturator membrane.  The medial aspect of muscles are covered with obturator fascia and leads to formation of the tendinous arch for the pelvic diaphragm attachment. 
  3. Posterior Wall
    1. Anterior sacro-iliac sacrospinous, and sacrotuberous ligaments. 
  4. Pelvic Floor
    1. ​​coccygeus, levator ani (puborectalis, iliococcygeus, pubococcygeus.)

21

What forms the antero-inferior pelvic wall?

  • pubic rami and the pubic symphysis. 
    • structures that hold the weight of the bladder. 

22

What are the structures of the lateral pelvic wall?

 

  1. Lateral Pelvic Wall
    1. R/L hip bones with the overlaying obturator membrane.  The medial aspect of muscles are covered with obturator fascia and leads to formation of the tendinous arch for the pelvic diaphragm attachment. 

 

23

Compare the general structure of male and female pelvis.

  • Male: thick and heavy
  • Female: thin light

24

What are the differences of the greater pelvis of the male and female.

  • Male: deep greater pelvis
  • Female: Shallow greater pelvis

25

Compare the M/F lesser pelvis

  • Male: narrow, deep, tapering
  • Female: Wide, shallow, cylindrical

26

Compare the pelvic inlet of M/F

  • Male: heart shaped and narrow
  • Female: oval and wide

27

Compare the pubic arches for male and female/

  • Male: < 70 degrees
  • Female: > 80 degrees

28

What muscle in the pelvis overlays the obturator internus?

THe levator ani. 

29

What are the components of the pelvic diaphragm?

1. Puborectalis, pubococcygeus, iliococcygeus, and coccygeus.

30

What distributes to the abdominal ureter, testis, epididymis?

Testicular artery. Anastamoses with cremaster artery and ductus deferens artery

31

What contributes to the abdominal ureter, ovary, ampulla of the uterine tube?

Ovarian artery, anastamosing with uterine artery via ovarian branches

32

What contributes to the superior part of the rectum?

the superior rectal artery. anastamosing with middle/inferior rectal artery. 

33

What feeds inferior lumbar, sacrum, and coccyx with blood?

Median sacral artery

34

What feeds pelvic organs, gluteal muscles, and perineum with blood? 

internal iliac arter

35

What feeds superior medial thigh, perineum, and pelvic viscera?

Anterior division of the internal iliac artery.

36

What supplies the superior aspect of the bladder and ductus deferens?

The umbilical and superior vesical artery

37

What supplies the  pelvic muscles, illium and femoral head? 

Obturator artery

38

What supplies medial compartment thigh, inferior bladder, pelvic ureters, prostate, seminal glands, ductus deferens?

Inferior vesical artery

 

39

What supplies the uterus, ligament of uterus, medial uterine tube, medial ovary, and superior aspect of vagina?

The uterine artery

40

What does the vaginal artery supply?

  • Vaginal branch: supplies lower vagina, vestibular bulb, and adjacent rectum 
    • Inferior vesical branch: supplies the fundus of bladder

41

What does the internal pudendal artery supply?

perineum, anal, and UG triangle.

42

The middle rectal artery supplies what?

Inferior rectum, seminal glands, and the prostate.

43

The piriformis, gluteus maximus, gluteus minimus, gluteus medius, and tensor fascia lata are all fed by what? 

Superior gluteal artery. 

44

The pelvic diaphragm, piriformis, quadratus femoris, gluteus maximus, and sciatic nerve are supplied via what artery?

Inferior gluteal. 

45

External iliac LN receive drainage from?

  • Receive: inguinal and pelvic viscera
  • Drain to: common Iliac LN
    •  

46

The internal iliac LN receive and drain lymph....

  • Receive: Inferior pelvic viscera, deep perineum, and gluteal region
  • Drains to: common Iliac LN. 
  • located around the anterior/posterior division of the internal iliac artery

47

The sacral LN drain and receive lymph from....

  • Receive: posterior inferior pelvic viscera
  • Drain to: The internal or Common Iliac LN.
  • Located in the concavity of the sacrum adjacent to median sacral vessels

48

Describe lymph drainage of the Common iliac LN

  • Receives: External/Internal iliac nodes and the sacral nodes
  • Drain to: Along the lumbar nodes, possibly into thoracic duct
  • located superior to the pelvic brim following the common iliac vessels

49

What is important to remember with regards to surgical procedure and intervention?

The uterine artery must be ligated and this can allow for damage to the ureter. The ureter passes inferiorly near the fornix of the vagina.

50

In the male, what is a continuation of the duct of epididymis?

  • Ductus deferens which crosses over the external iliac vessels. 
  • Eventually joins the seminal gland duct to form the ejaculatory duct.

51

What structures pass anterior to the ureter?

ductus deferens and the gonadal artery.

52

What is the function of the seminal gland?

  • combines with the ductus deferens to form the ejaculatory duct. 
  • Secretes fructose in a highly alkaline secretion to provide safe and nutrient-rich environment for sperm.

53

Where can the ejaculatory duct be found?

Arises at the neck of the bladder, running antero-inferiorly through the posterior prostate paralleling the prostatic utricle ( tiny slits allowing for convergence at the prostatic utricle)

54

Describe the location of the prostate:

  • Base
  • Apex
  • Anterior surface
  • Posterior surface

  • Base: near the neck of bladder
  • Apex: in contact with fascia on the superior aspect of the urethral sphincter
  • Anterior surface: Transverse muscle fibers form part of the urethral sphincter
  • Posterior surface: Falls along the ampulla of the rectum

55

What happens in the nervous system during ejaculation?

The sympathetics constrict the internal urethral sphincter. The ductus deferens rapidly increases peristalsis along with contraction of the seminal and prostatic glands. Thereby forcing out sperm and seminal fluid.   

The parasympathetics innervate the cavernosum plexus and provide erections 

56